Effectiveness and safety of tranexamic acid in lumbar spine decompression and fusion with internal fixation

English Keywords:Lumbar decompression and instrumented fusion surgery  Postoperative drainage  Tranexamic acid  Perioperative period

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of intravenous tranexamic acid(TXA) administration during posterior lumbar spine decompression and instrumented fusion. Methods: We retrospectively analyzed 957 patients who had undergone lumbar decompression and fusion with internal fixation in our center between December 2020 and October 2024. According to whether received intravenous tranexamic acid(TXA), the patients were divided into TXA group and control group. The TXA group included 507 cases, with 229 males and 278 females, aged 57.9±12.7 years; The control group included 450 cases, with 184 males and 266 females, aged 59.0±12.0 years. Baseline demographics(age, BMI, fused segments) were comparable between TXA group and control group(P>0.05). Data on general demographics, biochemical indices(hemoglobin, erythrocyte pressure volume, platelet count, coagulation function, liver and kidney function), blood management parameters(pulmonary blood volume, intraoperative and postoperative blood loss, drainage volume, and transfusion rates), and surgery-related complications were collected and compared between the TXA group and the control group. Further subgroup analysis was performed within the TXA group according to the TXA administration dosage: 316 patients who received a low dose of TXA(1g) either preoperatively or intraoperatively were assigned to the low-dose group, while 191 patients who received TXA preoperatively and an additional supplementary dose intraoperatively were allocated to the high-dose group. The above mentioned indicators and complications were compared between the two subgroups. Results: In comparison to the control group, the TXA group exhibited significantly reduced intraoperative blood loss(462.9±297.9mL vs 520.0±370.2mL, P<0.05), total blood loss(619.6±377.0mL vs 685.9±448.9mL, P<0.05), and postoperative drainage volume(1d: 162.7±84.1mL vs 242.1±133.8mL; total: 362.6±237.1mL vs 477.1±282.8mL, both P<0.05). Postoperative biochemical analysis revealed that the D-dimer level in the TXA group was significantly lower than that in the control group(1.9±2.1mg/L vs 2.4±2.6mg/L, P<0.05), but there were no significant differences in hemoglobin, coagulation function(PT, APTT, TT), or liver/renal function(ALT, AST, BUN, Scr)(P>0.05). No statistical difference existed in the incidence of postoperative complications between the two groups. In the subgroup analysis within the TXA group, the high-dose group showed significantly reduced blood loss(432.9±272.3mL vs 493.0±312.5mL) and postoperative 1d drainage(152.5±65.6mL vs 174.0±97.0mL) compared to the low-dose group. No significant differences were observed in other indicators(P>0.05). Conclusions: Intravenous administration of TXA during lumbar decompression and instrumented fusion surgery can significantly reduce intraoperative blood loss and postoperative drainage volume without increasing the incidence rate of related complications. Furthermore, high-dose TXA demonstrates superior efficacy in controlling total perioperative blood loss compared to low-dose regimens, without elevating the risk of thrombosis.