Topical Tranexamic Acid Reduces Postoperative Blood Loss in Posterior Spinal Fusion with Instrumentation: A Retrospective Clinical Study of Patients with Thoracolumbar Spinal Injury
Weera Sudprasert MD1, Terdpong Tanaviriyachai MD1, Kongtush Choovongkomol MD1, Sarut Jongkittanakul MD1, Urawit Piyapromdee MD1
Affiliation : 1 Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Background : There is limited literature regarding the topical use of tranexamic acid [TXA] to control postoperative bleeding
in posterior spinal fusion [PSF] procedures, operations which often required blood transfusions.
Objective : To evaluate the effect of topically applied TXA on postoperative blood loss in patients undergoing conventional
open PSF surgeries.
Materials and Methods: A retrospective study was conducted on a total of 73 patients who had spinal injuries of the
thoracolumbar vertebrae and who had undergone long-segment instrumented PSF without decompression between January
2011 and April 2015. Thirty-five patients were assigned to be given topical TXA (1 g/20 mL) and then their drain was
clamped for 2 hours. Thirty-eight patients in the control group were treated using similar procedures but with continuous
drainage and without antifibrinolytic agents.
Results : The rate of postoperative packed red cells [PRC] transfusion was significantly lower in the topical TXA group than
in the control group (11.4% vs. 44.7%; p = 0.002; relative risk, 0.26; 95% confidence interval, 0.1 to 0.69). Median drainage
blood loss, median days to drain removal and median postoperative hospitalization were significantly less in the topical TXA
group (p<0.05). Multinomial logistic regression analysis indicated that the use of topical TXA was a significant factor in
reducing the rate of postoperative PRC transfusion (p = 0.004).
Conclusion : The use of topically administered 1 g TXA in thoracolumbar spinal trauma cases undergoing PSF with long-
segment instrumentation reduces postoperative transfusion requirements, decreases the total amount of drainage blood loss,
lessen the time to drain removal and shortens the period of postoperative hospitalization.
Keywords : Tranexamic acid, Postoperative hemorrhage, Spinal fusion, Pedicle screws, Spinal injuries, Thoracic vertebrae, Lumbar vertebrae
