P145. The effect of tranexamic acid on operative and postoperative blood loss in transforaminal lumbar interbody fusion

• Published in: The spine journal 2022-09, Vol.22 (9), p.S196-S197
• Main Authors: Kanhere, Arun, Lambrechts, Mark, D'Antonio, Nicholas, Reddy, Yashas, Slota, Paul, Canseco, Jose A, Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., Schroeder, Gregory Douglas
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2022.06.402

Spine surgery is associated with the potential for significant blood loss, and adequate hemostasis is essential to visualizing crucial structures during the approach and procedure. Tranexamic acid is a fibrinolysis inhibitor known to reduce perioperative blood loss and subsequent blood transfusions. Although its use has been extensively studied in the pediatric and adult spinal deformity literature, there is a dearth of literature on its efficacy in reducing blood loss for 1 to 3 level lumbar fusion patients. The purpose of this study was to evaluate the effect of TXA on reducing perioperative blood loss and length of stay. Retrospective cohort study. Patients over the age of 18 who underwent primary or revision 1-3 level TLIF for degenerative conditions or deformity were included. Patients with a past medical history of coagulopathy, bleeding disorders, seizures, blood clots, cancer, motor disease, chronic kidney disease, were dialysis dependent or had surgery for trauma, infection or tumor were excluded. Surgery length, estimated blood loss, calculated blood loss, length of stay, and surgical drain output (day 0, 1, 2, and total). All patients at two affiliated institutions between 2015-2020 were screened for 1-3 level TLIF. Patients who received a preoperative loading dose of TXA followed by maintenance dose were grouped and compared to patients who didn't receive TXA. Calculation of blood loss was conducted using the Gross equation: BV (Blood Volume) = k1 x height (m)3 + k2 x weight (kg) + k3, where k1=0.3669, k2=0.03219, and k3=0.6041 for men and k1=0.3561, k2=0.03308, and k3=0.1833 for women. Hemoglobin loss (Hgbtotal) was then calculated using the Hemoglobin balance method: Hgbtotal = BV x (Hgbpre-Hgbpost) x 0.001. Finally, Blood Volume Loss (BVL) could be calculated: BVL = 1000 x (Hgbtotal/Hgbpre). A total of 498 patients including 253 males and 244 females with an average age of 60.1±11.3 years met inclusion criteria. Patients who received preoperative TXA had more comorbidities (p-0.006), longer surgery length (p < 0.001), longer length of stay (p=0.004), and decreased total (p=0.018) and post-op day 0 (p < 0.001) drain output. Multiple linear regression analysis demonstrated TXA was not associated with a change in EBL (p=0.793), calculated blood loss (p=0.709), or length of stay (p=0.833), but was independently associated with decreased day 0, 1, 2, and total drain output (p < 0.001, p=0.001, p=0.007, p < 0.001, respectively). The application of