The Effect of Intravenous Tranexamic Acid Before and During Spinal Surgery in Bleeding Volume During and After Surgical Operation

April 2019, Vol 5, Issue 2, No 17 Research Paper: The Effect of Intravenous Tranexamic Acid Before and During Spinal Surgery in Bleeding Volume During and After Surgical Operation Majid Rezvani1 , Homayoun Tabesh1, Meisam Adimi1* , Mohammad Alavi1, Abolfazl Zareian1, Mitra Rahiminejad2, Mehrdad Lari2 1. Department of Neurosurgery, Alzahra Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2. Department of Neurology, Alzahra Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Use your device to scan and read the article online Citation: Rezvani M, Tabesh H, Adimi M, Alavi M, Zareian A, Rahiminejad M, Lari M. The Effect of Intravenous Tranexamic Acid Before and During Spinal Surgery in Bleeding Volume During and After Surgical Operation Iran J Neurosurg. 2019; 5(2):71-78. http:// dx.doi.org/10.32598/irjns.5.2.71 : http://dx.doi.org/10.32598/irjns.5.2.71 ABSTRACT Article info: Received: 17 Dec 2018 Accepted: 10 Mar 2019 Available Online: 01 April 2019 Background and Aim: Bleeding during surgery is one of the most common surgical complications. In this study, we decided to determine the effect of Tranexamic Acid (TA) in reducing blood loss in patients undergoing spinal surgeries. Methods and Materials/Patients: In this clinical trial, 100 patients undergoing spinal surgeries were randomly divided into two groups. One group received TA and the other was selected as the control group. Patients in the treatment group received 1 gram of intravenous TA and another 250 milligram intravenously, one hour after the beginning of the surgery. Bleeding during the surgery, in the first 24 hours and the first 48 hours were recorded separately. The need for transfusion and its volume, as well as the hospital stay length were compared in the two groups. Results: Bleeding during surgery in TA group was significantly lower than that in the control group (433 ml vs. 522 ml respectively, P=0.009). Also, during the first 24 hours after surgery, bleeding in TA group was significantly less than that in the control group (P=0.011). During the second 24 hours after surgery, bleeding was similar between the two groups (P=0.112). The values of hemoglobin in both groups slowly decreased and the trend of decrease was not significantly different between them (P=0.154). Keywords: Tranexamic acid, Spinal surgery, Surgical bleeding, Blood transfusion Conclusion: In spinal surgeries, TA administration in the beginning of the process reduces surgical bleeding during surgery and in the first 24 hours after surgery. Considering the possible complications, TA administration is suggested for patients with hemoglobin less than 12 g/dl. Future studies are needed to conclude the advantages and disadvantages of TA administration in spinal surgeries. * Corresponding Author: Meisam Adimi, MD. Address: Department of Neurosurgery, Alzahra Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Tel: +98 (31) 33563466 E-mail: 71 April 2019, Vol 5, Issue 2, No 17 Highlights ● In spinal surgeries, tranexamic acid administration in the beginning of the process reduces surgical bleeding during surgery and in the first 24 hours after surgery. ● Transfusion requirements, reduction in hemoglobin level, duration of operation and length of hospital stay were independent of TA administration in this study. ● Tranexamic acid administration may have adverse effects on hospitalization period, related to complications such as deep vein thrombosis, especially in women. Plain Language Summary Bleeding during surgery is one of the most common surgical complications. In this study, we decided to determine the effect of Tranexamic Acid (TA) in reducing blood loss in patients undergoing spinal surgeries. In this clinical trial, 100 patients undergoing spinal surgeries were randomly divided into two groups. One group received TA and the other was selected as the control group. Patients in the treatment group received 1 gram of intravenous TA and another 250 milligram intravenously, one hour after the beginning of the surgery. Bleeding during the surgery, in the first 24 hours and the first 48 hours were recorded separately. The need for transfusion and its volume, as well as the hospital stay length were compared in the two groups. Bleeding during surgery in TA group was significantly lower than that in the control group (433 ml versus 522 ml respectively). Also, during the first 24 hours after surgery, bleeding in TA group was significantly less than that in the control group. During the second 24 hours after surgery, bleeding was similar between the two groups. The values of hemoglobin in both groups slowly decreased and the trend of decrease was not significantly different between them. In spinal surgeries, TA administration in the beginning of the process reduced surgical bleeding during surgery and in the first 24 hours after surgery. Considering the possible complications, TA administration is suggested for patients with hemoglobin less than 12 g/dl. Future studies are needed to conclude the advantages and disadvantages of TA administration in spinal surgeries. L 1. Introduction aminectomy and laminotomy are the most common treatments for discectomy. Lumbar disc herniation has been associated with lumbar canal stenosis in 15% to 45% of patients with disc herniation. Canal stenosis is considered to be a degenerative disorder with neurological symptoms in lower limbs, which can reduce the quality of life in patients [1, 2]. Decompression with laminectomy is the most common surgical treatment for lumbar canal stenosis, which is performed to alleviate pain and reduce symptoms. [3-5] Bleeding during surgery is one of the most common surgical complications [1-5]. Tranexamic Acid (TA) prevents lysis of blood clots through plasmin deactivation. TA is the chemical analog for lysin and combines with plasminogen and plasmin, which inhibits their ability to bind with lysin residue in fibrin, therefore preventing fibrinolysis. Studies have reported that TA decreases blood loss and that patients require less transfusion of blood products under general anesthesia during urologic, orthopedic, cardiovascular and liver transplant surgeries [6-11]. Besides, prophylac- 72 tic transfusion of antifibrinolytic products, such as TA has been shown to improve hemostasis. However, the results are still controversial [12-17]. Local TA in epidural area has been shown to significantly reduce blood loss after surgical laminectomy in the first and second days after surgery as well as total blood loss, therefore reducing duration of hospitalization [13]. Local TA has also been shown to reduce blood loss in patients undergoing spinal surgery using screw fixation [15]. To date, the effect of intravenous TA in reducing blood loss as well as assessing its adverse effects in spinal surgeries has not been well studied. In this study, we decided to determine t (...truncated)