Elsevier

World Neurosurgery

Volume 127, July 2019, Pages e1185-e1189
World Neurosurgery

Original Article
Different Effects of Intravenous, Topical, and Combined Application of Tranexamic Acid on Patients with Thoracolumbar Fracture

https://doi.org/10.1016/j.wneu.2019.04.095Get rights and content

Objective

To observe the efficacy of intravenous, topical, and combined application of tranexamic acid (TXA) in patients with thoracolumbar fracture fixed with percutaneous pedicle screw, and to identify the optimal application method of TXA.

Methods

A total of 181 patients with thoracolumbar fracture treated with percutaneous pedicle screw fixation were enrolled in this randomized controlled trial and were randomly classified into 3 groups, including group A (intravenous group), group B (topical group), and group C (combined group). The total blood loss (TBL), hidden blood loss (HBL), intraoperative blood loss (IBL), preoperative D-dimer, postoperative D-dimer, incidence of deep vein thrombosis (DVT), and incidence of other complications were compared and analyzed among the 3 groups.

Results

TBL, HBL, and IBL in the topical group 24 hours after operation were higher (P < 0.05) than those in the intravenous group and combined group, whereas the difference between the intravenous group and combined group was not statistically significant. Meanwhile, there was no statistically significant difference in operation time, preoperative D-dimer, and postoperative D-dimer among the 3 groups (P > 0.05), but D-dimer in all groups at 72 hours after surgery was higher than that before surgery. No DVT or other complication was observed in the patients.

Conclusions

Preoperative intravenous drip of TXA can remarkably reduce intraoperative HBL and IBL in patients with thoracolumbar fracture fixed with percutaneous pedicle screw. Nonetheless, intraoperative topical application of TXA before wound closure is not recommended.

Introduction

With the development of minimally invasive spinal surgery, the percutaneous pedicle screw technique has been extensively applied in clinic. Compared with traditional open surgery, minimally invasive percutaneous pedicle screw fixation can attain comparable clinical efficacy in treating thoracolumbar fractures, but it has exhibited obvious advantages in terms of operation time, intraoperative blood loss (IBL), and length of stay.1, 2 However, previous studies3, 4 have only focused on blood loss, such as IBL and postoperative drainage, and few of them have reported total blood loss (TBL) and hidden blood loss (HBL). HBL can lead to postoperative anemia, which will thereby affect postoperative functional recovery and increase the risk of incidence of complications.5, 6 As a result, it remains urgent to solve the problem of reducing the HBL amount in treatment of thoracolumbar fractures through minimally invasive percutaneous pedicle screw fixation. Tranexamic acid (TXA), a commonly used hemostatic agent in orthopedic surgery, has also been extensively applied in spine surgery.7 Moreover, the effectiveness of TXA on preoperative intravenous infusion or topical use has also been verified by relevant studies.8, 9, 10, 11 However, no existing literature has reported the effect of TXA on reducing perioperative blood loss in treating thoracolumbar fractures by minimally invasive percutaneous pedicle screw fixation.12 In this prospective and single-blind study, 181 patients undergoing minimally invasive percutaneous pedicle screw fixation for thoracolumbar fracture with no nerve injury were randomly selected from our department from January 2016 to December 2017 and were divided into 3 groups to assess the best way for application of TXA.

Section snippets

Patients

From January 1, 2017, a total of 185 patients were included and divided into an intravenous group (group A), topical group (group B), and combined group (group C), according to a random number table. Patients were asked to randomly select a number plate ranging from 1 to 185 preoperatively; among them, 1–62 were in group C, 63–124 were in group B, and 125–185 were in group A. Meanwhile, 4 of the 185 patients were lost to follow-up (Figure 1). For the 61 cases in the intravenous group,

Outcome Measures and Statistical Analysis

For evaluation during the perioperative period, the time from injury to surgery, preoperative hematocrit (Hct), postoperative Hct, preoperative D-dimer, and D-dimer at 72 hours after surgery were recorded. Meanwhile, the presence of DVT in bilateral lower limbs was confirmed by ultrasound examination at 24 hours before surgery and 72 hours after surgery. Complications, including hematoma, infection, DVT, pulmonary embolism, myocardial ischemia, and ischemic encephalopathy, were also recorded at

Results

The operations were successfully performed in all patients. No wound infection, nerve injury, or other secondary operation was reported at 1 week after surgery. There were 61 cases in the intravenous group, including 34 men and 27 women, with an age of 45.43 ± 8.18 years and body mass index (BMI) of 21.26 ± 2.26 kg/m2. Regarding the fracture sites, 4 cases were at T11, 16 were at T12, 30 were at L1, and 11 were at L2. The time from injury to surgery was 4.27 ± 2.00 days.

There were 61 patients

Discussion

As one of the representative minimally invasive spinal surgical techniques, the percutaneous pedicle screw technique has been extensively applied in clinic. Existing studies suggest2 that treating thoracolumbar fracture with no neurologic symptoms by percutaneous pedicle screw is associated with the advantages of short operation time, less IBL, less soft tissue damage, and rapid postoperative recovery. However, perioperative HBL is neglected. There is no postoperative drainage when treating

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  • Cited by (0)

    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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