Safety and efficacy of administration of tranexamic acid in posterior decompression fixation surgery of lung cancer spinal metastases

English Keywords:Spinal metastases  Lung cancer  Tranexamic acid  Blood loss  Blood transfusion

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and efficacy of intravenous injection of tranexamic acid(TXA) in reducing the perioperative blood loss in patients with lung cancer spinal metastases undergoing posterior decompression surgery. Methods: A retrospective analysis was conducted on 68 patients with lung cancer spinal metastases who underwent decompression surgery between May 2011 and August 2022, with an average age of 63.1±1.3 years. Among them, there were 42 males and 26 females. According to whether received intravenous injection of 1g TXA after the start of anesthesia to operation within 30mins, the patients were divided into observation group(26 cases) and control group(46 cases). The following data were collected including general information[age, gender, American Society of Aneshesiologists physical status classification system(ASA) grade, and the use of oral anticoagulant or antiplatelet drugs], tumor related information(pathological types and systemic treatments), laboratory related information(preoperative HGB, Hct, PLT, PT, APTT, and postoperative 1d Hct), and surgical related information(decompression site, exposed segment, surgical type, surgical time, blood transfusion volume on the day of surgery, postoperative drainage volume and drainage tube retention time, and postoperative hospitalization status), as well as the data related to lower limb venous thrombosis during postoperative hospitalization. The total blood loss was calculated using Gross′s formula. t-test, Mann Whitney U test, and chi square test were used to evaluate the differences between the two groups. Results: There were no statistically significant differences between the two groups of patients in general information and tumor-related information such as age, gender, ASA grading, pathological type, and the use of oral anticoagulant or antiplatelet drugs(P>0.05). The preoperative HGB levels in the observation group were significantly lower than those in the control group(P=0.035), while there were no statistically significant differences in other preoperative laboratory data such as Hct, PLT, PT, and APTT(P>0.05). There were no statistically significant differences between the two groups of patients in terms of surgical decompression site, surgical type, exposed segment, and surgical time(P>0.05). The blood loss in the observation group was significantly lower than that in the control group[961.3.4(741.5, 1810.4)mL vs 1593.5(1170.2, 1936.1)mL, P=0.013]. The blood transfusion volume of the observation group was significantly lower than that of the control group[400(0, 800)mL vs 800(400, 800)mL, P=0.024]. There were no significant differences between the two groups in terms of drainage volume, drainage tube retention time, postoperative hospitalization time, and newly developed lower limb venous thrombosis after surgery(P>0.05). Conclusions: Intravenous injection of 1g TXA after the start of anesthesia to operation within 30mins can reduce the blood loss and transfusion volume in patients with lung cancer spinal metastases undergoing posterior decompression surgery.