Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for lumbar canal stenosis with/without instability: A prospective randomized double-blinded placebo control study

Introduction: Lumbar stenosis is a common disorder, commonly occurring at L4-5, with up to 91% of patients having neural compression at this level. Degenerative spinal stenosis with or without instability requiring multilevel spine surgery is associated with large blood loss. Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. The objectives of the study were to assess the efficacy of TXA in reducing perioperative blood loss and assess the complications associated with its administration and need for blood transfusion during posterior lumbar spine surgery for lumbar canal stenosis (LCS). Methodology: Between November 2018 and August 2020, 130 adult patients (age 18–70 years) with LCS undergoing posterior lumbar instrumented spinal fusions at our institution were divided into TXA and control groups. Outcomes assessed are intraoperative blood loss (IOBL) and postoperative blood loss (POBL), hematocrit, need for allogeneic blood transfusion, and complications such as deep vein thrombosis, myocardial infarction, stroke, and seizures postoperatively. Results: There was a statistically highly significant reduction in the mean IOBL, POBL, mean postoperative hemoglobin, and postoperative packed cell volume in the tranexamic group compared to the control group. There was no significant statistical difference in need for blood transfusion among the two groups. No complications were observed in either group associated with administration of TXA. Conclusion: Prophylactic use of low-dose TXA provides an effective and safe method for reduction of blood loss during and after LCS surgeries. Low-dose TXA does not significantly affect the duration of surgery or need for blood transfusion. Higher-level multicentric studies are required to evaluate the safety of TXA in multilevel lumbar spine surgeries.