Effect of Tranexamic Acid on Blood Loss and Transfusion Requirements in Lumbar Spine Fixation

Background: Lumbar spine surgery in adults is associated with significant blood loss, often requiring allogeneic blood transfusion. The objective of this study was to evaluate the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss and transfusion requirements in patients undergoing lumbar spine fixation. Materials and Methods: Sixty adult patients were randomized to receive either a bolus of 10 mg/kg IV of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr of TXA up to closure of skin, or an equivalent volume of normal saline. Outcome measures included perioperative blood loss, amount of blood transfusion, as well as postoperative hemoglobin and hematocrit levels. Results: The mean intra-operative blood loss and the amount of blood in the drains post-operatively was less in the tranexamic acid group compared to the placebo group (P =0.0001). The blood transfusions received in both the groups was not statistically significant (P = 0.362).However, clinically there was reduction of transfusion requirement in the tranexamic acid group. The drop in post-operative hemoglobin levels was statistically significant in the control group as compared to tranexamic acid group (P = 0.002). The mean duration of surgery was less in tranexamic acid group compared to the control group (P = 0.008). Conclusion: Thus, tranexamic acid is effective in reducing peri-operative blood loss and transfusion requirements .Furthermore, TXA administration was not associated with any significant complications including DVT.