The Comparison of Systemic and Local Tranexamic Acid Application Use in Reducing Bleeding in Spinal Surgery

Hesarikia, Hamid; Rahimnia, Alireza; Farzanegan, Gholamreza; Anbarloui, Musa Reza; Hamidzadeh Khiyavi, Amin

doi:10.22034/ijos.2022.306738.1013

The Comparison of Systemic and Local Tranexamic Acid Application Use in Reducing Bleeding in Spinal Surgery

Document Type : Original Article

Authors

Hamid Hesarikia ¹

Alireza Rahimnia ²

Gholamreza Farzanegan ³

Musa Reza Anbarloui ⁴

Amin Hamidzadeh Khiyavi ⁵

¹ Assistant Professor of Orthopaedics, Baqiyatallah University of Medical Sciences, Tehran, Iran.

² Professor and Head of Orthopaedic Department,, Baqiyatallah University of Medical Sciences, Tehran, Iran.

³ Associate Professor and Head of Neurosurgery Department,, Baqiyatallah University of Medical Sciences, Tehran, Iran.

⁴ Assistant Professor, Department of Neurosurgery,, Baqiyatallah University of Medical Sciences, Tehran, Iran.

⁵ Assistant Professor of Orthopaedics,, Baqiyatallah University of Medical Sciences, Tehran, Iran.

https://doi.org/10.22034/ijos.2022.306738.1013

Abstract

Background: The application of Tranexamic Acid (TA) is one of the methods to control and reduce bleeding in spinal surgery. The aim is to compare systemic (TA) with local (TA) administration for reduction of blood loss during spinal surgery in order to promote health economics.
Method: The research schema was cross-sectional and retrospective in the community of patients undergoing spinal surgery in the Baqiyatallah Hospital. The inclusion criteria were elective spinal surgeries of three levels or more. The exclusion criteria were bleeding disorder. The required analyses are performed using SPSS software. Moreover, the significance level of the statistical test is 0.05 The intravenous dose is selected to be 10 mg/kg. The maintenance is also 1 mg/kg/h. The topical dosage is one gram in300 ml at the beginning and 500 mg in 50 ml at the end. The amount of calculated bleeding is the volume of blood in the drain.
Results: In this research, 22 patients (44.9% of 49 patients) received TA intravenously and 27 patients (55.1% of 49 patients) received local TA. There was no remarkable relationship between the amount of bleeding in different groups with the surgery type (p: 0.48), surgery level number (p: 0.48), and the amount of total bleeding (p: 0.14). The local TA group’s intra-operative and post-operative bleeding amounts were 563.89 ± 367.48ml and 116.30 ± 71.37ml, respectively. These intra-operative and post-operative bleeding amounts were 496.64 ± 296.84ml and 75.84 ± 120ml for the case of the intravenous (TA) group.
Conclusion: The results do not confirm the effectiveness of the local administration compared with the intravenous administration. However, the average amount of bleeding in the local application of tranexamic acid is similar to the systemic one.

Keywords

Intravenous Administration

Topical Administration

Tranexamic acid

Spinal Fusion

Bleeding

1. Sundstrom A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case-control study using the General Practice Research Database. BJOG. 2009; 116(1):91-7. doi: 10.1111/j.1471-0528.2008.01926.x

2. Seddighi A, Nikouei A, Seddighi AS, Zali A, Tabatabaei SM, Yourdkhani F, Naimian S, Razavian I. The role of tranexamic acid in prevention of hemorrhage in major spinal surgeries. Asian J Neurosurg. 2017; 12(3):501-505. doi: 10.4103/1793-5482.165791

3. Katzung B. Basic & clinical pharmacology. 14 th ed. New Yor: McGraw - Hill; 2018.

4. Li J, Wang L, Bai T, Liu Y, Huang Y. Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion. J Orthop Surg Res. 2020; 15(1):339. doi: 10.1186/s13018-020-01758-8

5. Yerneni K, Burke JF, Tuchman A, Li XJ, Metz LN, Lehman RA Jr, et al. Topical tranexamic acid in spinal surgery: A systematic review and meta-analysis. J Clin Neurosci. 2019; 61:114-119. doi: 10.1016/j.jocn.2018.10.121

6. Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bago J. Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial. Br J Anaesth. 2017; 118(3):380-390. doi: 10.1093/bja/aew434

7. World Health Organization. WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage. Geneva: World Health Organization; 2017.

8. Rezvani M, Tabesh H, Adimi M, Alavi M, Zareian A, Rahiminejad M et al . The effect of intravenous tranexamic acid before and during spinal surgery in bleeding volume during and after surgical operation. Iran J Neurosurg. 2019; 5‌ (2):71-78.

9. Reed M.R., Woolley L.T. Uses of tranexamic acid. Cont Educ Anaesth Crit Care Pain. 2015; 15:32-37.

10. Sean C, Sweetman PS. Martindale: The complete drug reference. London, England, UK: Pharmaceutical Press; 2011.

11. Winter SF, Santaguida C, Wong J, Fehlings MG. Systemic and topical use of tranexamic acid in spinal surgery: A systematic review. Global Spine J. 2016; 6(3):284-95. doi: 10.1055/s-0035-1563609

12. Arun-Kumar V, Naresh-Babu J. Is there a role for preoperative local infiltration of tranexamic acid in elective spine surgery? A prospective randomized controlled trial analyzing the efficacy of intravenous, local infiltration, and topical administration of tranexamic acid. Global Spine J. 2021; 11(1):21-27. doi: 10.1177/2192568219888446

13. Sudprasert W, Tanaviriyachai T, Choovongkomol K, Jongkittanakul S, Piyapromdee U. A randomized controlled trial of topical application of tranexamic acid in patients with thoracolumbar spine trauma undergoing long-segment instrumented posterior spinal fusion. Asian Spine J. 2019; 13(1):146-154. doi: 10.31616/asj.2018.0125