ANALYSIS OF TRANEXAMIC ACID USAGE IN ADULT SPINAL DEFORMITY PATIENTS WITH RELATIVE CONTRAINDICATIONS IN PAKISTAN

MA JAVED; BU UJJAN; MH AMJAD; A ANWER; NA KHAN; . FAIZUDDIN; N KHAN; MIU HAQ

doi:10.54112/bcsrj.v2024i1.951

Authors

MA JAVED Department Of Neurosurgery, Akbar Niazi Teaching Hospital/ IMDC, Islamabad, Pakistan
BU UJJAN Department Of Neurosurgery, Dow International Medical College and Hospital Ojha Campus, Karachi, Pakistan
MH AMJAD Department Of Neurosurgery, Hameed Latif Hospital, Lahore, Pakistan
A ANWER Department Of Neurosurgery, University College of Medicine and Dentistry, The University of Lahore, Lahore, Pakistan
NA KHAN Department Of Neurosurgery PIMS, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
. FAIZUDDIN Department of Neurosurgery, Shaikh Khalifa Bin Zeyyad Hospital, Quetta, Pakistan
N KHAN Department Of Dental Materials, CIMS Dental College Multan, Pakistan
MIU HAQ Department of Neurosurgery, Hayathabad Medical Complex Hospital Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.951

Keywords:

Blood Loss, Surgical Spinal Deformities Tranexamic Acid Blood Transfusion Postoperative Complications

Abstract

Patients who require complex spinal surgery require a huge amount of blood transfusion perioperatively. The anemia, the formation of hematoma, and increased coagulation properties, which are consequences of massive blood loss itself can negatively affect the postoperative clinical results.Objectives: The main objective of the study is to find the tranexamic acid usage in adult spinal deformity patients with relative contraindications in Pakistan. Methodology of the study: This prospective observational study was conducted at Pakistan institute of medical sciences from 2016-2020. Data were collected from 185 patients of spine deformity.Data were collected through a combination of medical record reviews and direct patient interviews. Demographic details, including age, gender, weight, and height, were recorded for each of the 185 patients. Comprehensive medical histories were obtained to identify comorbid conditions and relative contraindications for tranexamic acid (TXA) use, such as a history of thromboembolic events, renal impairment, and concurrent anticoagulant therapy. Results: Data were collected from 185 patients according to criteria of the study. Mean age of the patients were 58.4 ± 12.3 years. Out of 185, there were 112 (60.5%) females and 73 (39.5%) male patients. Mean BMI was 28.1 ± 5.4 kg/m2. 49.7% were also suffering from hypertension, 24.3% from DM and 20% from osteoporosis.The regression coefficient (β) for total blood loss was -250 mL, with a 95% confidence interval (CI) of [-300, -200], and a p-value of < 0.001. Similarly, the regression coefficient for the number of blood transfusions was -1.2 units, with a 95% confidence interval of [-1.5, -0.9], and a p-value of < 0.001.Conclusion: Tranexamic acid effectively reduces blood loss and transfusion requirements in adult spinal deformity surgeries, even among patients with relative contraindications. The associated complication rates are manageable with careful patient selection and monitoring.

Downloads

Download data is not yet available.

References

Nguyen A, Brown NJ, Gendreau J, Nguyen BA, Pennington Z, Zhang A, et al. The association of thromboembolic complications and the use of tranexamic acid during resection of intracranial meningiomas: systematic review and meta-analysis of randomized controlled trials. Journal of Neurosurgery. 2023;140(4):1008-18.

Clohisy JC, Lenke LG, Dafrawy MHE, Wolfe RC, Frazier E, Kelly MP. Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery. Spine deformity. 2022;10(6):1399-406.

Cartagena-Reyes MA, Silva-Aponte JA, Nazario-Ferrer GI, Benes GA, Choudhary A, Raad M, et al. The cost–utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion. Spine deformity. 2024;12(3):587-93.

Fatima N, Barra ME, Roberts RJ, Massaad E, Hadzipasic M, Shankar GM, et al. Advances in surgical hemostasis: a comprehensive review and meta-analysis on topical tranexamic acid in spinal deformity surgery. Neurosurgical Review. 2021;44:163-75.

Weissmann KA, Lafage V, Barrios Pitaque C, Lafage R, Descazeaux FM. Efficacy of topical versus intravenous tranexamic acid in spinal deformity. European Spine Journal. 2020;29:3044-50.

Haddad AF, Ames CP, Safaee M, Deviren V, Lau D. The effect of systemic tranexamic acid on hypercoagulable complications and perioperative outcomes following three-column osteotomy for adult spinal deformity. Global spine journal. 2022;12(3):423-31.

Ko B-S, Cho K-J, Kim Y-T, Park J-W, Kim N-C. Does tranexamic acid increase the incidence of thromboembolism after spinal fusion surgery? Clinical Spine Surgery. 2020;33(2):E71-E5.

Zhao Y, Xi C, Xu W, Yan J. Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery: a meta-analysis. Medicine. 2021;100(7):e24678.

Shrestha IK, Ruan T-Y, Lin L, Tan M, Na X-Q, Qu Q-C, et al. The efficacy and safety of high-dose tranexamic acid in adolescent idiopathic scoliosis: a meta-analysis. Journal of orthopaedic surgery and research. 2021;16:1-9.

Dunn LK, Chen C-J, Taylor DG, Esfahani K, Brenner B, Luo C, et al. Postoperative low-dose tranexamic acid after major spine surgery: a matched cohort analysis. Neurospine. 2020;17(4):888.

Ivasyk I, Chatterjee A, Jordan C, Geiselmann MT, Chang PS, Kamel H, et al. Evaluation of the safety of tranexamic acid use in pediatric patients undergoing spinal fusion surgery: a retrospective comparative cohort study. BMC Musculoskeletal Disorders. 2022;23(1):651.

Pernik MN, Dosselman LJ, Aoun SG, Walker AD, Hall K, Reyes VP, et al. The effectiveness of tranexamic acid on operative and perioperative blood loss in long-segment spinal fusions: a consecutive series of 119 primary procedures. Journal of Neurosurgery: Spine. 2020;32(5):768-74.

Ehresman J, Pennington Z, Schilling A, Medikonda R, Huq S, Merkel KR, et al. Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies. Journal of Neurosurgery: Spine. 2020;33(2):177-85.

Ikwuezunma IA, Margalit A, Sponseller PD. Tranexamic acid use is associated with reduced intraoperative blood loss during spine surgery for Marfan syndrome. Spine deformity. 2022:1-5.

Brown NJ, Pennington Z, Himstead AS, Yang CY, Chakravarti S, Gendreau J, et al. Safety and efficacy of high-dose tranexamic acid in spine surgery: a retrospective single-institution series. World Neurosurgery. 2023;177:e18-e25.