Efficacy and safety of tranexamic acid in anterior approach surgery for thoracolumbar fractures_West China Medical Journal

Authors：

HUANG Yong , HUANG Leizhen , FENG Ganjun , LIU Limin ,  SONG Yueming

Department of Orthopedic Surgery / Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SONG Yueming, Email: hx_sym@163.com

Keywords：

Tranexamic acid; Anterior approach surgery; Thoracolumbar fracture

DOI：

10.7507/1002-0179.202008218

Video：

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Objective To explore the effectiveness and safety of tranexamic acid (TXA) in anterior approach surgery for thoracolumbar fractures.Methods From January 2017 to January 2020, a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group (n=33) and control group (n=35). Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion, while the ones in the control group were given 15 mg/kg of normal saline at the same time. Basic data of the patients were collected. The hemoglobin concentration, hematocrit, coagulation and fibrinolysis indexes of the patients were monitored preoperatively, 24-hour postoperatively, and 72-hour postoperatively. The intraoperative blood loss and wound drainage of the patients were recorded. The incidence of blood transfusion and thrombotic events were collected. Statistical analysis was performed.Results There was no significant difference in age, sex, body mass index, operation time, fracture location distribution, anesthesia classification of American Society of Anesthesiologists, neurologic grade of American Spinal Injury Association, injury time, or length of hospital stay between the two groups (P>0.05). Compared with those in the control group, the total blood loss [(1 398.49±312.24) vs. (1 642.30±357.78) mL, P=0.003], intraoperative blood loss [(432.83±74.76) vs. (486.31±86.51) mL, P=0.008], and wound drainage [(276.73±89.42) vs. (389.24±125.71) mL, P<0.001] in the TXA group reduced. No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit (P>0.05), but the 24-hour postoperative hemoglobin concentration [(112.67±20.59) vs. (102.64±19.41) g/L, P=0.042] and hematocrit [(32.25±4.12)% vs. (30.13±4.28)%, P=0.042] in the TXA group were higher than those in the control group. The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control group (6.1% vs. 25.7%, P<0.05). There was no statistically significant difference in preoperative, 24-hour postoperative, or 72-hour postoperative prothrombin time, international standardized ratio, activated partial prothrombin time, platelet count, fibrinogen, d-dimer, or fibrinogen degradation products between the two groups (P>0.05), and no thrombotic complications were found.Conclusion TXA has good efficacy and safety in the anterior approach surgery for thoracolumbar fractures.

Citation： HUANG Yong, HUANG Leizhen, FENG Ganjun, LIU Limin, SONG Yueming. Efficacy and safety of tranexamic acid in anterior approach surgery for thoracolumbar fractures. West China Medical Journal, 2020, 35(10): 1164-1169. doi: 10.7507/1002-0179.202008218 Copy

1.	Smith JS, Shaffrey CI, Ames CP, et al. Treatment of adult thoracolumbar spinal deformity: past, present, and future. J Neurosurg Spine, 2019, 30(5): 551-567.
2.	Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: a meta-analysis. J Orthop, 2016, 13(4): 383-388.
3.	Kato S, Murray JC, Kwon BK, et al. Does surgical intervention or timing of surgery have an effect on neurological recovery in the setting of a thoracolumbar burst fracture?. J Orthop Trauma, 2017, 31(Suppl 4): S38-S43.
4.	Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures. Spine J, 2014, 14(1): 145-164.
5.	Shin SR, Lee SS, Kim JH, et al. Thoracolumbar burst fractures in patients with neurological deficit: anterior approach versus posterior percutaneous fixation with laminotomy. J Clin Neurosci, 2020, 75(75): 11-18.
6.	Kirkpatrick JS. Thoracolumbar fracture management: anterior approach. J Am Acad Orthop Surg, 2003, 11(5): 355-363.
7.	Taam J, Qj Y, Pang KS, et al. Current evidence and future directions of tranexamic acid use, efficacy, and dosing for major surgical procedures. J Cardiothorac Vasc Anesth, 2020, 34(3): 782-790.
8.	Xiong H, Liu Y, Zeng Y, et al. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord, 2018, 19(1): 321.
9.	Leff J, Rhee A, Nair S, et al. A randomized, double-blinded trial comparing the effectiveness of tranexamic acid and epsilon-aminocaproic acid in reducing bleeding and transfusion in cardiac surgery. Ann Card Anaesth, 2019, 22(3): 265-272.
10.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
11.	Rosenthal BD, Boody BS, Jenkins TJ, et al. Thoracolumbar burst fractures. Clin Spine Surg, 2018, 31(4): 143-151.
12.	Morrissey PB, Shafi KA, Wagner SC, et al. Surgical management of thoracolumbar burst fractures: surgical decision-making using the AOSpine thoracolumbar injury classification score and thoracolumbar injury classification and severity score. Clin Spine Surg, 2020.
13.	Piccone L, Cipolloni V, Nasto LA, et al. Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury, 2020, 51(2): 312-316.
14.	Tan T, Huang MS, Mathew J, et al. Anterior versus posterior approach in the management of AO Type B1 & B2 traumatic thoracolumbar fractures: a level 1 trauma centre study. J Clin Neurosci, 2020, 72(72): 219-223.
15.	Lin Y, Cohen R, Armali C, et al. Transfusion-associated circulatory overload prevention: a retrospective observational study of diuretic use. Vox Sang, 2018, 113(4): 386-392.
16.	Roubinian NH, Triulzi DJ. Transfusion-associated circulatory overload and transfusion-related acute lung injury: etiology and prevention. Hematol Oncol Clin North Am, 2019, 33(5): 767-779.
17.	Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia, 2015, 70(Suppl 1): 50-53, e18.
18.	Pong RP, Leveque JA, Edwards A, et al. Effect of tranexamic acid on blood loss, D-Dimer, and fibrinogen kinetics in adult spinal deformity surgery. J Bone Joint Surg Am, 2018, 100(9): 758-764.
19.	Guo J, Gao X, Ma Y, et al. Different dose regimes and administration methods of tranexamic acid in cardiac surgery: a meta-analysis of randomized trials. BMC Anesthesiol, 2019, 19(1): 129.
20.	Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The efficacy of tranexamic acid in total knee arthroplasty: a network meta-analysis. J Arthroplasty, 2018, 33(10): 3090-3098.
21.	Goobie SM, Zurakowski D, Glotzbecker MP, et al. Tranexamic acid is efficacious at decreasing the rate of blood loss in adolescent scoliosis surgery: a randomized placebo-controlled trial. J Bone Joint Surg Am, 2018, 100(23): 2024-2032.
22.	Du Y, Feng CC. The efficacy of tranexamic acid on blood loss from lumbar spinal fusion surgery: a meta-analysis of randomized controlled trials. World Neurosurg, 2018, 119(119): e228-e234.
23.	Mcleod LM, French B, Flynn JM, et al. Antifibrinolytic use and blood transfusions in pediatric scoliosis surgeries performed at US children’s hospitals. J Spinal Disord Tech, 2015, 28(8): E460-E466.
24.	Yee BE, Wissler RN, Zanghi CN, et al. The effective concentration of tranexamic acid for inhibition of fibrinolysis in neonatal plasma in vitro. Anesth Analg, 2013, 117(4): 767-772.
25.	Kim KT, Kim CK, Kim YC, et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J, 2017, 26(11): 2851-2857.
26.	Johnson DJ, Johnson CC, Goobie SM, et al. High-dose versus low-dose tranexamic acid to reduce transfusion requirements in pediatric scoliosis surgery. J Pediatr Orthop, 2017, 37(8): e552-e557.
27.	HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet, 2020, 395(10241): 1927-1936.

1. Smith JS, Shaffrey CI, Ames CP, et al. Treatment of adult thoracolumbar spinal deformity: past, present, and future. J Neurosurg Spine, 2019, 30(5): 551-567.
2. Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: a meta-analysis. J Orthop, 2016, 13(4): 383-388.
3. Kato S, Murray JC, Kwon BK, et al. Does surgical intervention or timing of surgery have an effect on neurological recovery in the setting of a thoracolumbar burst fracture?. J Orthop Trauma, 2017, 31(Suppl 4): S38-S43.
4. Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures. Spine J, 2014, 14(1): 145-164.
5. Shin SR, Lee SS, Kim JH, et al. Thoracolumbar burst fractures in patients with neurological deficit: anterior approach versus posterior percutaneous fixation with laminotomy. J Clin Neurosci, 2020, 75(75): 11-18.
6. Kirkpatrick JS. Thoracolumbar fracture management: anterior approach. J Am Acad Orthop Surg, 2003, 11(5): 355-363.
7. Taam J, Qj Y, Pang KS, et al. Current evidence and future directions of tranexamic acid use, efficacy, and dosing for major surgical procedures. J Cardiothorac Vasc Anesth, 2020, 34(3): 782-790.
8. Xiong H, Liu Y, Zeng Y, et al. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord, 2018, 19(1): 321.
9. Leff J, Rhee A, Nair S, et al. A randomized, double-blinded trial comparing the effectiveness of tranexamic acid and epsilon-aminocaproic acid in reducing bleeding and transfusion in cardiac surgery. Ann Card Anaesth, 2019, 22(3): 265-272.
10. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
11. Rosenthal BD, Boody BS, Jenkins TJ, et al. Thoracolumbar burst fractures. Clin Spine Surg, 2018, 31(4): 143-151.
12. Morrissey PB, Shafi KA, Wagner SC, et al. Surgical management of thoracolumbar burst fractures: surgical decision-making using the AOSpine thoracolumbar injury classification score and thoracolumbar injury classification and severity score. Clin Spine Surg, 2020.
13. Piccone L, Cipolloni V, Nasto LA, et al. Thoracolumbar burst fractures associated with incomplete neurological deficit in patients under the age of 40: is the posterior approach enough? Surgical treatment and results in a case series of 10 patients with a minimum follow-up of 2 years. Injury, 2020, 51(2): 312-316.
14. Tan T, Huang MS, Mathew J, et al. Anterior versus posterior approach in the management of AO Type B1 & B2 traumatic thoracolumbar fractures: a level 1 trauma centre study. J Clin Neurosci, 2020, 72(72): 219-223.
15. Lin Y, Cohen R, Armali C, et al. Transfusion-associated circulatory overload prevention: a retrospective observational study of diuretic use. Vox Sang, 2018, 113(4): 386-392.
16. Roubinian NH, Triulzi DJ. Transfusion-associated circulatory overload and transfusion-related acute lung injury: etiology and prevention. Hematol Oncol Clin North Am, 2019, 33(5): 767-779.
17. Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia, 2015, 70(Suppl 1): 50-53, e18.
18. Pong RP, Leveque JA, Edwards A, et al. Effect of tranexamic acid on blood loss, D-Dimer, and fibrinogen kinetics in adult spinal deformity surgery. J Bone Joint Surg Am, 2018, 100(9): 758-764.
19. Guo J, Gao X, Ma Y, et al. Different dose regimes and administration methods of tranexamic acid in cardiac surgery: a meta-analysis of randomized trials. BMC Anesthesiol, 2019, 19(1): 129.
20. Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The efficacy of tranexamic acid in total knee arthroplasty: a network meta-analysis. J Arthroplasty, 2018, 33(10): 3090-3098.
21. Goobie SM, Zurakowski D, Glotzbecker MP, et al. Tranexamic acid is efficacious at decreasing the rate of blood loss in adolescent scoliosis surgery: a randomized placebo-controlled trial. J Bone Joint Surg Am, 2018, 100(23): 2024-2032.
22. Du Y, Feng CC. The efficacy of tranexamic acid on blood loss from lumbar spinal fusion surgery: a meta-analysis of randomized controlled trials. World Neurosurg, 2018, 119(119): e228-e234.
23. Mcleod LM, French B, Flynn JM, et al. Antifibrinolytic use and blood transfusions in pediatric scoliosis surgeries performed at US children’s hospitals. J Spinal Disord Tech, 2015, 28(8): E460-E466.
24. Yee BE, Wissler RN, Zanghi CN, et al. The effective concentration of tranexamic acid for inhibition of fibrinolysis in neonatal plasma in vitro. Anesth Analg, 2013, 117(4): 767-772.
25. Kim KT, Kim CK, Kim YC, et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J, 2017, 26(11): 2851-2857.
26. Johnson DJ, Johnson CC, Goobie SM, et al. High-dose versus low-dose tranexamic acid to reduce transfusion requirements in pediatric scoliosis surgery. J Pediatr Orthop, 2017, 37(8): e552-e557.
27. HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet, 2020, 395(10241): 1927-1936.

West China Medical Journal

Efficacy and safety of tranexamic acid in anterior approach surgery for thoracolumbar fractures

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