The Safety And Effectiveness Of Tranexamic Acid In Posterior Lumbar Interbody Fusion

Objective To assess the safety and efficacy of intravenous tranexamic acid(TXA)in posterior lumbar interbody fusion(PLIF).Methods We identified 98 patients with lumbar stenosis underwent single level PLIF surgery(January 2017 to July 2017)in our hospital.There were 58 patients combined with our inclusion criterias.According to the TXA usage,the cohort was divided into two groups(TXA group(30 cases)and control group(28 cases)).In the TXA group,an intravenous TXA at the dosage of 15 mg/kg was given 15 minutes before skin incision in 15 minutes,and then the equal amount of TXA was used 8 hours later.The equal amount of normal saline was given in the control group.The base line information,operation time,total blood loss,visible blood loss,hidden blood loss,intraoperative blood loss,drainage volume within 24 hours after surgery and drainage volume 24 hours after surgery until the drainage tube was pulled out were collected and calculated.The blood cell analysis,coagulation function,pre-thrombosis markers,liver and renal function,inflammation markers,deep vein thrombosis(DVT)and other complications were also collected.The clinical effects were analyzed by Japanese orthopaedic association(JOA),oswestry disability index(ODI),visual analogue scale(VAS)and bone fusion rate.Results There were significantly less total blood loss(894 ± 324 ml),visible blood loss(380 ± 109 ml),intraoperative blood loss(197 ± 70 ml),drainage volume within 24 hours after surgery(134 ± 58 ml),drainage volume of 24 hours after surgery until the drainage tube was pulled out(50 ± 28 ml)in TXA group compared with those(1339 ± 330 ml?815 ± 226 ml?266 ± 78 ml?381 ± 136 ml and 168 ± 66 ml)of the control group(P<0.05).However,there was no significantly difference between the two groups in hidden blood loss.There were no significant differences in live and renal function,coagulation function and inflammation markers between the two groups during the perioperative period.In addition,in terms of fibrinolytic indicators,the differences in D-Dimer and fibrinogen between the two groups were not statistically significant during the perioperative period.The difference in fibrin degradation products between the two groups before surgery was not statistically significant,but the fibrin degradation products of the TXA group(12.97 ± 2.41mg/l and 7.08 ± 2.67 mg/l)were significantly lower than those of the control group(14.68 ± 3.54 mg/l and 8.75 ± 3.45 mg/l)at the first and third days after operation(P <0.05).There were no serious complications in the two groups.There were no significant differences in the JOA,ODI and VAS score pre-operation,1 months after operation,3 months after operation and 12 months after operation between the two groups.As for the fusion rate,there was no statistically differences in the two groups at 12 months after operation.Conclusions Intravenous TXA can effectively decrease perioperative blood loss in PLIF surgery without increasing the risk of adverse events,and thus it is worth to popularize.