Effects of intravenous and topical tranexamic acid on blood loss and inflammatory response after posterior cervical decompressive laminectomy

doi:10.12307/2024.092

Abstract

Abstract: BACKGROUND: With the increase of the incidence of cervical spondylosis, it is particularly important to control the postoperative bleeding and related inflammatory reaction of cervical vertebra.
OBJECTIVE: A prospective study was conducted to investigate the combined effect of intravenous and topical tranexamic acid of different concentrations on postoperative blood loss and inflammatory response during posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion.
METHODS: From January 2020 to December 2022, 150 patients who were scheduled to undergo posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion for cervical spondylotic myelopathy in Tianjin People’s Hospital were enrolled in the study. Patients were divided into A, B, and C groups (n=50) by randomized double-blind lottery. The patients in the A, B, and C groups were treated with 1%, 3%, and 5% intravenous and topical tranexamic acid solution, respectively. Postoperative blood loss and inflammation-related indicators were compared among three groups. The occurrence of venous thromboembolism and hematoma was observed after operation.
RESULTS AND CONCLUSION: (1) There were significant differences in blood loss-related indexes, such as intraoperative blood loss, overall blood loss, and occult blood loss among the three groups (P < 0.01). The above indexes were significantly lower in groups B and C than that in group A. There was no significant difference between groups B and C (P > 0.05). (2) On days 1 and 3 after surgery, the levels of inflammatory indicators including serum C-reactive protein and interleukin-6 were increased to varying degrees in the three groups compared to before surgery (P < 0.05). As the drug concentration increased, its expression decreased, and there was a significant difference among the three groups (P < 0.001). (3) Two cases of intramuscular venous thrombosis appeared in each of the three groups after surgery. No hematoma or pulmonary embolism occurred in all three groups. (4) It is concluded that in posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion, intravenous combined with topical application of different concentrations of tranexamic acid is effective in reducing perioperative blood loss and inflammatory response. 3% tranexamic acid achieves the same effect without significantly increasing the risk of postoperative venous thromboembolism.

Key words: tranexamic acid, posterior cervical decompressive laminectomy, perioperative, blood loss, inflammatory response

CLC Number:

Tan Yubo, Xia Yingpeng. Effects of intravenous and topical tranexamic acid on blood loss and inflammatory response after posterior cervical decompressive laminectomy[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(21): 3367-3372.

Figures/Tables 4

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