The Major Complications And Risk Factors Analysis Of High Dose TXA Used In Spinal Correction Surgery

Objective:This study investigated the clinical application of high-dose tranexamic acid(TXA)in 742 patients to explored the major complications and risk factors of high-dose TXA in spinal correction surgery.Methods:Retrospective analysis of the Center for all patients with Posterior Vertebral Column Resection(PVCR)and other spinal deformity correction surgery and the use of high-dose TXA regimen(100 mg.kg-1 before the incision,followed by 10 mg.kg-1.h-1 maintenance until the incision is closed)to reduce intraoperative blood loss.Collect all patients' age,gender,weight,surgical procedure,operation time,fixed fusion segment,intraoperative blood loss,blood transfusion volume,intraoperative mean arterial pressure,TXA dose,liver function,kidney function,coagulation function,urine volume,etc.index.All patients underwent routine examination of troponin and ECG monitoring to assess whether myocardial infarction or arrhythmia occurred.All patients underwent vascular ultrasound before and after surgery to confirm the presence or absence of venous thrombosis.Postoperative attention to patient consciousness,breathing,heart rate,blood pressure,oxygen saturation and other indicators,if there is a suspicious EEG to determine whether there is epilepsy,pulmonary CT to determine whether there is pulmonary embolism.TXA drug-related major complications were counted,and multiple logistic regression analysis was used to analyze the risk factors for complications.A long-term adverse event after drug administration was assessed using a medical history questionnaire at the end of follow-up.Results:A total of 742 patients were included in the study,including 314 males and 428 females,with an average age of(16±7)years,ranging from 2 to 48 years,of which 568 patients were followed for more than 2 years.There were 9 cases of TXA-related drug complications,and the total complication rate was about 1.2%.Among them,2 cases(0.3%)had non-fatal pulmonary embolism,3 cases(0.4%)had asymptomatic myocardial infarction,and 4 cases(0.5%)had arrhythmia,which occurred within 1 week after operation.All patients with complications recovered from hospital discharge.No renal function damage occurred in all patients,no liver function damage occurred,no epilepsy occurred,and no extremity venous thrombosis occurred.Patients who were followed up for more than 2 years had no epilepsy,myocardial infarction,pulmonary embolism,liver and kidney function damage,and moderate stroke events.Multiple regression analysis showed that the total dose of TXA and the age of patients were independent risk factors for the major complications of TXA-related drugs.Conclusion:The incidence of drug-related major complications in high-dose TXA for spinal correction surgery is low,about 1.2%.The use of high-dose tranexamic acid did not cause adverse events during long-term follow-up of patients.In this study,high-dose TXA drug-related complications were mainly concentrated in heart and lung complications,but no serious fatal complications occurred.High-dose TXA application of spinal orthopedic surgery was generally safe.The age of the patient and the large cumulative use of the drug are independent risk factors for complications.