Comparison of systemic Tranexamic acid injection with topical in reduction of bleeding during and after spinal surgery

Abstract

Massive perioperative blood loss in complex spinal surgery often requires blood transfusions and can negatively affect patient outcome. Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding. Recently, there has been interest in applying it topically before the closure of surgical wounds. This has the advantages of ease of application, maximum concentration at the site of bleeding, minimising its systemic absorption and, consequently, concerns about possible side-effects. Therefore, there is still insufficient clinical evidence for tranexamic acid administration methods as an effective hemostatic agent in spinal surgery. The aim of this study was to compare two methods of systemic and topical use of tranexamic acid in reduction of bleeding during and after spinal surgery. Methods: 60 patient’s candidates for fusion surgery were included in the study and were divided into two groups that received topical tranexamic acid in the first group and systemic tranexamic acid in the second group. At the end of the surgery, the amount of blood transfused during the operation and and the duration of hospitalization were recorded. Also possible complications during and after surgery such as infection, thromboembolism and seizures were recorded. Data were analyzed by SPSS version 20. A P-Value of < 0.05 was considered as statistically significant Results: Patients were similar in mean age, body weight, hemoglobin and hematocrit levels before and after surgery, bleeding, complications, and blood transfusion. The rate of blood loss in the local group was slightly higher than the systemic group, but the difference was not significant.