The Efficacy Of Different Doses Tranexamic Acid In The Reduction Of Blood Loss In Complex Posterior Lumbar Surgery

Part ? Efficacy of Tranexamic Acid on Reducing Blood Loss And Transfusion in Spine Surgery: a meta-analysis Object The aim of this meta-analysis is investigating the effectiveness of TXA for reducing perioperative blood loss and transfusion in spinal surgery.Methods Pub Med,EMBase,Cochrane library,CNKI and Vip databases were searched systematically to identify published studies(from establishment to June 2016).Only randomized controlled trials(RCTs)about TXA affected perioperative blood loss and transfusion in spinal surgery were included in the present study,and hand searched relevant studies were performed.The meta-analysis was conducted by Rev Man 5.3 software.The amount of intraoperative blood loss,total blood loss and amount of blood transfusion were analyzed by mean difference(MD).Results 9 RCTs were included in the study,with a total sample size of 631 patients.Compared with control group,the amount of intraoperative blood loss had a statistically significant difference(MD:-78.49 ml,95% CI [-145.98,-11.00];P=0.02);total blood loss had a statistically significant difference(MD:-150.86 ml,95% CI[-236.38,-65.34];P =0.0005);amount of blood transfusion had a statistically significant difference(MD:386.57 ml,95% CI [-679.99,-93.14];P=0.01).Conclusions TXA can effectively reduce intraoperative blood loss,total blood loss and amount of blood transfusion in spinal surgery,it has clinical significance.Part ? The Efficacy of Different Doses Tranexamic Acid in The Reduction of Blood Loss in Complex Posterior Lumbar Surgery: a prospective,randomized,double-blind,placebo-controlled,two center study.Object This study aimed to evaluate the effect and safety of tranexamic acid about three doses regimens in patients undergoing complex posterior lumbar surgery.Methods 220 eligible patients out of 305,from two hospitals during March 2015 to March 2016,were randomly assigned to HTXA group,MTXA group,LTXA group or PL group.Patients in the HTXA group were received a bolus dose of 30mg/kg TXA i.v,a maintenance dosage of 2mg/kg/h TXA,until the skin was sutured;patients in the MTXA group were received a bolus dose of 20mg/kg TXA i.v,a maintenance dosage of 1mg/kg/h TXA,until the skin was sutured;patients in the LTXA group were received a bolus dose of 10mg/kg TXA i.v,a maintenance dosage of 0.5mg/kg/h TXA,until the skin was sutured;patients in the PL group were received equivalent volume of normal saline,until the skin was sutured.The primary outcomes were intraoperative estimated blood loss,drainage,total blood loss;the secondary outcomes were postoperative hemoglobin,hematocrit levels and the number of patients receiving packed red blood.Results 220 patients were enrolled,each group had 55 patients,3 patients were excluded from the analyses.The demographic and baseline data between groups were not statistically different.The postoperative drainages had statistical difference between groups(P=0.009),HTXA group was less than any other group.The total blood loss also had statistical difference between groups(P=0.028),HTXA group was less than LTXA group and PL group,there were statistical difference,the other comparison between any two groups was no statistical difference.But,the intraoperative blood loss did not have statistical difference between groups(P=0.1),only HTXA group vs PL group had statistical difference,any other comparison between two groups was no statistical difference.One patients with a dural tear in the placebo group,no DVT,PE were found,the postoperative complications between groups were no statistical difference.Conclusions Tranexamic acid significantly reduced the perioperative blood loss in patients undergoing complex posterior lumbar surgery,HTXA is the optimal dose regimen in this kind of surgery;there is a tendency for MTXA to reduce the blood loss;LTXA does not reduce perioperative blood loss.Tranexamic acid can safely use in spinal surgery.Large sample RCT study should be conducted to test MTXA and LTXA hemostatic effect for spinal surgery.