Safety and Efficacy of High-Dose Tranexamic Acid in Spine Surgery: A Retrospective Single-Institution Series

Nolan J Brown; Zach Pennington; Alexander S Himstead; Chen Yi Yang; Sachiv Chakravarti; Julian Gendreau; Joshua Kurtz; Shane Shahrestani; Martin H Pham; Joseph A Osorio

doi:10.1016/j.wneu.2023.04.058

Safety and Efficacy of High-Dose Tranexamic Acid in Spine Surgery: A Retrospective Single-Institution Series

World Neurosurg. 2023 May 3:S1878-8750(23)00543-0. doi: 10.1016/j.wneu.2023.04.058. Online ahead of print.

Authors

Affiliations

¹ Department of Neurological Surgery, University of California, Irvine, Orange, California, USA.
² Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
³ Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA.
⁴ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁵ Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA.
⁶ Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA. Electronic address: jaosorio@health.ucsd.edu.

PMID: 37141940
DOI: 10.1016/j.wneu.2023.04.058

Abstract

Objective: Currently, tranexamic acid (TXA) is the most widely used antifibrinolytic agent in spine surgery and has been proven to reduce perioperative blood loss. However, the safety of high-dose regimens remains in established.

Methods: A retrospective chart review was performed to identify all adult patients who underwent spine surgery with high-dose TXA (50 mg/kg loading dose, mg/kg/h maintenance dose) between September 2019 and March 2020.

Results: Thirty-six patients were treated with intraoperative high-dose TXA during the study period. The mean age was 56.6 (range: 22-82). Average body mass index was 27.2 (5.1) kg/m2. Average preoperative Charlson Comorbidity Index was 3.0 (2.7). The mean number of spinal levels operated on was 6.9 (4.3). Seven cases (19.4%) were revision surgeries. The mean intraoperative blood loss was 587.1 (900.0) mL, and total blood loss was 623.8 (991.9) mL. Postoperatively, time to ambulation was on average 1.7 (1.7) days. The mean total length of stay was 9.8 days (7.9, range 2-41). The most common indication for surgery was tumor (n = 9, 25%), followed by fracture (n = 8, 22.2%), deformity (n = 7, 19.4%), pseudarthrosis (n = 6, 16.7%), and symptomatic lumbar disc herniation (n = 2, 5.6%). There were no thromboembolic or other significant complications among the 36 patients.

Conclusions: This retrospective case series demonstrates that the use of high-dose TXA provides is potentially safe and efficacious in adult patients undergoing complex spine surgeries. However, further investigations are required before the true safety and optimal dosing can be determined for high-dose TXA.

Keywords: Antifibrinolytic; Complications; Estimated blood loss; Hemostasis; Perioperative; Seizure; Spine surgery; TXA; Tranexamic acid; Venous thromboembolism.