Comparison of topical and intravenous tranexamic acid for reducing postoperative blood loss in single-level posterior lumbar interbody fusion: a retrospective study from Japan.

Abstract

Study design: A retrospective cohort study.

Purpose: This study aimed to compare the efficacy and safety of topical and relatively high-dose intravenous tranexamic acid (TXA) in minimizing postoperative blood loss in patients undergoing single-level posterior lumbar interbody fusion (PLIF).

Overview of literature: Topical TXA demonstrates a similar hemostatic efficacy to intravenous TXA. However, whether intravenous or topical TXA is more effective in minimizing postoperative bleeding in spine surgery remains unclear.

Methods: In total, 140 patients who underwent single-level PLIF were retrospectively enrolled and assigned to the (1) control group (n=58), which did not receive TXA; (2) TXA (iv) group (n=39), which was administered intravenously with a relatively high-dose (2 g) of TXA immediately before wound closure; and (3) TXA (t) group (n=43), which received topical application of TXA (1 g in 100 mL of saline solution) to the wound immediately before wound closure.

Results: No significant differences in age, body mass index, sex, preoperative hematological parameters, or intraoperative blood loss were found among the three groups. The total postoperative blood loss was significantly lower in the TXA (t) group than in the TXA (iv) and control groups (389.6±137.5 vs. 543.6±175.4 vs. 700.3±231.4, respectively; both p<0.01). Analysis of blood loss over time revealed significantly less blood loss throughout the postoperative period in the TXA (t) group than in the control group (p<0.01). In contrast, the TXA (iv) group showed less blood loss than the control group in 2-6 hours and 6-12 hours postoperatively (p<0.05). No complications, such as thromboembolic events, were associated with the use of either TXA formulation.

Conclusions: Following single-level PLIF, topical TXA exerts rapid and long-lasting effects on minimizing postoperative blood loss compared with twice the amount of intravenous TXA.