The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fractu
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ORIGINAL ARTICLE
The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture: a randomized double‑blinded controlled study Jieliang Shen1 · Zhengyang Yang1 · Mengyu Fu1 · Jie Hao1 · Wei Jiang1 Received: 15 December 2019 / Revised: 2 August 2020 / Accepted: 5 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate the safety and efficacy of topical use of tranexamic acid (TXA) on early operation for thoracolumbar burst fracture (TBF). Methods Patients with acute TBF requiring early decompression were prospectively collected. The enrolled patients were randomly assigned to TXA and control group, in which wound surface was soaked with TXA or the same volume of normal saline for 5 min after wound incision, respectively. The total blood loss (TBL), intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperatively (pre-op) and postoperatively, and amount of allogenic blood transfusion were recorded. Furthermore, the general information was also compared between groups. Results There were 39 and 37 patients enrolled in TXA and control group for final analysis. The demographics data showed no significant difference between groups (P > 0.05), but operation time and IBL were significantly decreased in TXA group (P 0.05), but HGB levels were significantly higher in the TXA group at POD1 (P < 0.05), without significant difference at POD3 (P > 0.05). Moreover, in the TXA group, the TBL and PBL were significantly less than those in the control group (P < 0.05), but there was no significant difference in HBL (P > 0.05) (Table 2).
Postoperative condition The postoperative ambulation time, removal time of drainage tube, and length of hospital stay were significantly less in the TXA group compared with those in control group (P < 0.05). One patient receiving TXA required administration of red cell suspension (RCS) postoperatively; in the control group, 5 patients needed postoperative RCS transfusion, of which the blood transfusion rate and volume were significantly lower in the TXA group (P < 0.05) (Table 3). At the final follow-up, no neurologic deteriorations were observed in both groups, who demonstrated an improvement in at least on ASIA grade level from baseline. There were no postoperative complications observed in both groups, such as myocardial infarction, cerebral vascular accident, deep vein thrombosis, pulmonary embolism, wound complications, or hematoma formation within the spinal canal; moreover, none of the TXA-related complications occurred in patients postoperatively, such as seizures, nausea, diarrhea, renal failure.
Discussion This is the first double-blinded RCT to evaluate the efficacy and safety of topical TXA application after wound incision for early operation on TBF. The main finding in this study revealed that topical use of TXA had a remarkably decreased volume of TBL, IBL, and PBL, of which the decreased IBL was beneficial for intraoperative manip
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