본문 바로가기
KERD
논문KCI 등재

Tranexamic Acid and Intraoperative and Postoperative Accumulative Bleeding in Elective Degenerative Spine Surgery

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류의학일반

초록

Purpose: Spinal surgeries are often associated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the importance of antifibrinolytic drugs during spinal surgeries to reduce blood loss, which can also reduce the risk of the need for blood transfusions. We evaluated the effects of prophylactic, low-dose tranexamic acid (TXA) in spinal fusion surgeries on blood loss, blood transfusions, and associated complications. Materials and Methods: TXA was administered to 90 patients at a constant infusion rate of 10 mg/kg for 20 minutes after anes thesia induction, followed by a maintenance dose of 1 mg/kg/h until the end of the operation. An additional 91 patients were in cluded as controls. Results: There were no significant differences between the study groups in terms of intraoperative blood loss, which was 500 mL for both groups (p>0.999). Also, intraoperative blood transfusion requirements were similar between both groups (p=0.330). Mean blood transfusion amounts were 125±35 mL for patients in the TXA group and 85±25 mL in the control group. However, there was a significant reduction in postoperative blood transfusion (p=0.003) in the TXA group. Only three cases in the TXA group required blood transfusion, while 15 cases in the control group did. Conclusion: We confirmed that low dose TXA has no effect on intraoperative blood loss volume or blood transfusion requirements and that it can significantly reduce the need for postoperative blood transfusions.

Abstract

Purpose: Spinal surgeries are often associated with a high incidence of perioperative blood loss, which poses several complications. Much current research focuses on the importance of antifibrinolytic drugs during spinal surgeries to reduce blood loss, which can also reduce the risk of the need for blood transfusions. We evaluated the effects of prophylactic, low-dose tranexamic acid (TXA) in spinal fusion surgeries on blood loss, blood transfusions, and associated complications. Materials and Methods: TXA was administered to 90 patients at a constant infusion rate of 10 mg/kg for 20 minutes after anes thesia induction, followed by a maintenance dose of 1 mg/kg/h until the end of the operation. An additional 91 patients were in cluded as controls. Results: There were no significant differences between the study groups in terms of intraoperative blood loss, which was 500 mL for both groups (p>0.999). Also, intraoperative blood transfusion requirements were similar between both groups (p=0.330). Mean blood transfusion amounts were 125±35 mL for patients in the TXA group and 85±25 mL in the control group. However, there was a significant reduction in postoperative blood transfusion (p=0.003) in the TXA group. Only three cases in the TXA group required blood transfusion, while 15 cases in the control group did. Conclusion: We confirmed that low dose TXA has no effect on intraoperative blood loss volume or blood transfusion requirements and that it can significantly reduce the need for postoperative blood transfusions.

참고문헌 (43)

  1. Zhang Y, "Does tranexamic acid improve bleeding, transfusion, and hemoglobin level in patients undergoing multilevel spine surgery? A systematic review and meta-analysis", World Neurosurg, 127, pp.289~301 (2019)
  2. Yoo JS, "The use of tranexamic acid in spine surgery", Ann Transl Med (2019)
  3. 최호영, "Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery", 대한신경외과학회지, 60(1), pp.75~81 (2017), 대한신경외과학회
  4. Cheriyan T, "Efficacy of tranexamic acid on surgical bleeding in spine surgery : a meta-analysis", Spine J, 15, pp.752~761 (2015)
  5. Hanada K, "Castigating intraoperative bleeding : tranexamic acid, a new ally", Asian J Neurosurg, 16, pp.51~55 (2021)
  6. Mallepally Abhinandan Reddy, "Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion", Asian Spine Journal, 14(5), pp.593~600 (2020), 대한척추외과학회[DOI]
  7. Ehresman J, "Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies", J Neurosurg Spine, 33, pp.177~185 (2020)
  8. Jordan M, "Prevention of postoperative bleeding in hip fractures treated with prosthetic replacement : efficacy and safety of fibrin sealant and tranexamic acid. A randomised controlled clinical trial(TRANEXFER study)", Arch Orthop Trauma Surg, 139, pp.597~604 (2019)
  9. Yang B, "Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery", PLoS One, 8, pp.e55436~ (2013)
  10. Koster A, "Moderate dosage of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures : incidence and clinical outcome", Br J Anaesth, 110, pp.34~40 (2013)
  11. 이성, "Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome", Yonsei Medical Journal, 47(3), pp.326~332 (2006), 연세대학교의과대학
  12. Fletcher ND, "Development of consensus based best practice guidelines for perioperative management of blood loss in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis", Spine Deform, 6, pp.424~429 (2018)
  13. 김광렬, "Surgical Strategy for Sacral Tumor Resection", Yonsei Medical Journal, 62(1), pp.59~67 (2021), 연세대학교의과대학[DOI]
  14. Grant JA, "Perioperative blood transfusion requirements in pediatric scoliosis surgery : the efficacy of tranexamic acid", J Pediatr Orthop, 29, pp.300~304 (2009)
  15. Lin ZX, "Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery", Orthopedics, 39, pp.119~130 (2016)
  16. Rajaee SS, "Spinal fusion in the United States: analysis of trends from 1998 to 2008", Spine (Phila Pa 1976), 37, pp.67~76 (2012)
  17. Wang Q, "Tranexamic acid reduces postoperative blood loss of degenerative lumbar instability with stenosis in posterior approach lumbar surgery : a randomized controlled trial", Eur Spine J, 22, pp.2035~2038 (2013)
  18. Wong J, "Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery", Anesth Analg, 107, pp.1479~1486 (2008)
  19. Moslem Shakeri, "Minimal Dose of Tranexamic Acid Is Effective in Reducing Blood Loss in Complex Spine Surgeries: A Randomized Double-Blind Placebo Controlled Study", Asian Spine Journal, 12(3), pp.484~489 (2018), 대한척추외과학회
  20. Farrokhi MR, "Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery : a randomized clinical trial", J Neurosurg Anesthesiol, 23, pp.290~296 (2011)
  21. Elmose S, "Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery : no effect on operative time, intraoperative blood loss, or complications", J Neurosurg Spine, 31, pp.194~200 (2019)
  22. Zhu J, "Efficacy and safety of tranexamic acid in total hip replacement : a PRISMA-compliant meta-analysis of 25 randomized controlled trials", Medicine(Baltimore), 96, pp.e9552~ (2017)
  23. Lin JD, "Safety of a high-dose tranexamic acid protocol in complex adult spinal deformity : analysis of 100 consecutive cases", Spine Deform, 6, pp.189~194 (2018)
  24. Zhang H, "The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty : a meta-analysis", Knee Surg Sports Traumatol Arthrosc, 20, pp.1742~1752 (2012)
  25. Nagabhushan RM, "Effectiveness and safety of batroxobin, tranexamic acid and a combination in reduction of blood loss in lumbar spinal fusion surgery", Spine(Phila Pa 1976), 43, pp.E267~73 (2018)
  26. Kim KT, "The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion : a double-blinded, placebo-controlled randomized study", Eur Spine J, 26, pp.2851~2857 (2017)
  27. Abou-Diwan C, "Plasma and cerebral spinal fluid tranexamic acid quantitation in cardiopulmonary bypass patients", J Chromatogr B Analyt Technol Biomed Life Sci, 879, pp.553~556 (2011)
  28. Peters A, "Antifibrinolytics reduce blood loss in adult spinal deformity surgery : a prospective, randomized controlled trial", Spine(Phila Pa 1976), 40, pp.E443~9 (2015)
  29. Baldus CR, "Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls", Spine(Phila Pa 1976), 35, pp.235~239 (2010)
  30. Johnson DJ, "High-dose versus low-dose tranexamic acid to reduce transfusion requirements in pediatric scoliosis surgery", J Pediatr Orthop, 37, pp.e552~e557 (2017)
  31. Zufferey P, "Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?", Anesthesiology, 105, pp.1034~1046 (2006)
  32. Colomina MJ, "Intraoperative tranexamic acid use in major spine surgery in adults : a multicentre, randomized, placebo-controlled trial", Br J Anaesth, 118, pp.380~390 (2017)
  33. Bianco K, "Complications and intercenter variability of three-column osteotomies for spinal deformity surgery : a retrospective review of 423 patients", Neurosurg Focus, 36, pp.E18~ (2014)
  34. Sethna NF, "Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery", Anesthesiology, 102, pp.727~732 (2005)
  35. Newton PO, "Antifibrinolytic agents reduce blood loss during pediatric vertebral column resection procedures", Spine(Phila Pa 1976), 37, pp.E1459~63 (2012)
  36. Shapiro F, "Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis", Spine(Phila Pa 1976), 32, pp.2278~2283 (2007)
  37. Huang F, "The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery : a meta-analysis", J Surg Res, 186, pp.318~327 (2014)
  38. Ma TK, "Manifestation of tranexamic acid toxicity in chronic kidney disease and kidney transplant patients: a report of four cases and review of literature", Nephrology (Carlton), 22, pp.316~321 (2017)
  39. Verma K, "Reduction of mean arterial pressure at incision reduces operative blood loss in adolescent idiopathic scoliosis", Spine Deform, 1, pp.115~122 (2013)
  40. Mikhail C, "Minimizing blood loss in spine surgery", Global Spine J, 10(1 Suppl), pp.71S~83S (2020)
  41. Xie J, "Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery", Spine J, 15, pp.647~654 (2015)
  42. Ramirez MG, "Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes", Hosp Pract (1995), 46, pp.189~196 (2018)
  43. Esposito F, "Gelatin-thrombin hemostatic matrix in neurosurgical procedures : hemostatic effectiveness and economic value of clinical and surgical procedure-related benefits", J Neurosurg Sci, 64, pp.158~164 (2016)

관련 논문AI추천

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty선종근, Cheng Jin, Eun-Kyoo Song, Jatin Prakash, Seung-Hun Lee, Yong-Jin Park, Young-Jun Seol대한슬관절학회 · Knee Surgery and Related Research2016 · 제28권 제3호Blood Sparing Efficacy of Oral Tranexamic Acid in Primary Total Knee Arthroplasty: A Randomized Controlled TrialQunn Jid Lee, Wai Yee Ching, Yiu Chung Wong대한슬관절학회 · Knee Surgery and Related Research2017 · 제29권 제1호Prospective randomized trial comparing efficacy and safety of intravenous and intra-articular tranexamic acid in total knee arthroplastyChau Wai-Wang, Cheung Kin-Wing, Chiu Kwok-Hing, Chung Kwong-Yin, Ho Kevin Ki Wai, Kwok Jojo Yan-Yan, Li Moses Man-Lung대한슬관절학회 · Knee Surgery and Related Research2020 · 제32권 Intravenous Injection of Tranexamic Acid in Patients with Pelvic Fractures: A Prospective Randomized TrialAbdelazeem Ahmed Hazem, Abdelrazek Ahmed Magdy, Fahmy Mahmoud, Karim Mahmoud Abdel대한고관절학회 · Hip and Pelvis2025 · 제37권 제1호Comparison of Blood Loss between Neutral Drainage with Tranexamic Acid and Negative Pressure Drainage without Tranexamic Acid Following Primary Total Knee Arthroplasty정성, 김동휘, 박상하, 박치형, 이광철, 이상홍대한슬관절학회 · Knee Surgery and Related Research2016 · 제28권 제3호Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trialsAbdullah AMA Almubarki, Ahmed Abu-Zaid, Ahmed Ghazi, Bayan Albouq, Ehab Badghish, Fatimah Shakir Abualsaud, Hany Salem, Ismail A Al-Badawi, Khalid Khadawardi, Latifa F AlNaim, Meshael Fodaneel, Mohammed Ziad Jamjoom, Nora F AlNaim, Osama Alomar, Rayan AlSghan, Saeed Baradwan, Safa Alabdrabalamir, Saud Owaimer Alsehaimi대한산부인과학회 · Obstetrics & Gynecology Science2022 · 제65권 제5호

이 간행물의 다른 논문 (14건)