Junior Specialist UC Irvine Department of Neurosurgery Santa Clarita, California, United States
Introduction: Previous literature has repeatedly demonstrated the effective use of antifibrinolytic agents such as tranexamic acid (TXA) for reducing blood loss during spine surgery. However, there is concern that high doses of TXA may increase the risk of complications, such as thromboembolism or seizure. The purpose of this retrospective case series was to delineate perioperative outcomes and complications in patients that underwent spinal procedures with administration of high-dose TXA (2350 mg – 7500 mg) at a single institution.
Methods: A retrospective chart review was performed on all adult patients who received surgery in the cervical, thoracic, or lumbar regions between September 2019 and March 2020. The total dose of TXA administered during the surgery along with perioperative complications were recorded.
Results: Thirty-six patients were treated with intraoperative high-dose TXA during the study period. Mean age was 56.6 (range: 22 – 82). Average BMI was 27.2 (5.1) kg/m2. Average preoperative CCI was 3.0 (2.7). Mean number of spinal levels operated on was 6.9 (4.3). Seven cases (19.4%) were revision surgeries. Of the 36 cases, 1 included pedicle subtraction osteotomy (2.8%), 4 included vertebral column resection (11.1%), and 20 included a posterior column osteotomy (55.6%). Mean intraoperative blood loss was 587.1 (900.0) mL, and total blood loss was 623.8 (991.9) mL. Postoperatively, time to ambulation was on average 1.7 (1.7) days. Mean total length of stay was 9.8 days (7.9, range 2 – 41). The most common indication for surgery was tumor (n=9, 25%), followed by fracture (n=8, 22.2%), deformity (n=7, 19.4%), pseudarthrosis (n=6, 16.7%), and degenerative disc disease (n=2, 5.6%). There were no thromboembolic or other significant complications among the 36 patients.
Conclusion : This retrospective case series demonstrates that the use of high-dose TXA provides a safe and effective outcome in adult patients undergoing spine surgery.
