Tranexamic Acid and Major Spine Surgery: Trends and Controversies

Image
Excessive bleeding often complicates spine surgery. This may result in increased morbidity and mortality. The amount of blood loss depends on many factors. Нe extent of a surgical procedure is the principal cause of a blood loss during spine surgery. Perioperative coagulation dysfunction is also an important factor leading to an excessive blood loss during lengthy spinal surgeries. Tranexamic Acid (TA) is safely used for the prevention of blood transfusion for major joint replacement procedures. The benefit and safety of tranexamic TA in patients undergoing major spinal fusion is not completely established. Nevertheless, TA appears to have a potential role in the management of spinal surgery. Identifying patients at risk plays paramount importance in preventing excessive blood loss. The role of a surgeon cannot be overestimated. Optimal positioning to minimize epidural venous bleeding, including intraoperative normovolemic hemodilution, cell salvaging, minimization of a surgical invasiveness, staging of a procedure and administration of various antifibrinolytic agents is utilized with various success to lessen perioperative blood loss in patients undergoing spine surgery. What method is the most ejٴective, safest or advantageous remains unclear. Antifibrinolytic agents, including TA, could be valuable adjuncts to perioperative hemorrhage management. TA is a widely used antifibrinolytic agent. The beneficial role and efficacy of TA in reducing perioperative blood loss and need for blood transfusion is evident. TA is administered orally, intramuscularly, intravenously or topically for a wide variety of surgical procedures. The efficacy of antifibrinolytic agents is described in a wide variety of surgical procedures: liver transplantation, obstetrics and gynecology, trauma and orthopedic surgical procedures. Bleeding oіen complicates spine surgery. This results in increased morbidity and mortality. The extent of a surgical procedure is the principal cause of a blood loss. Perioperative coagulation dysfunction is also a factor leading to an excessive blood loss during lengthy spinal surgeries. TA efficacy in spine surgery is noticeable but most of the studies have either limited patient enrolment, mixed results or difficult to interpret. The eject of TA on the occurrence of thromboembolic events, strokes, myocardial ischemia, seizures and mortality has not been adequately assessed and needs to be elucidated. There is evidence that TA reduces the need for transfusion. The efficacy varies from study to study, depending on the type of surgery and many other factors. The benefit and safety of tranexamic TA in patients undergoing major spinal fusion is not completely established. Identifying patients at risk still plays paramount importance in preventing excessive blood loss and the role of a surgeon cannot be overestimated. Surgical hemostasis is obviously the most important. Topical and systemic pharmacological agents are of an additional merit. Judicious surgical hemostasis and procoagulant agents are complementary in managing hemorrhage. Media Contact: Kate Williams Editorial Assistant Journal of Surgery and Anesthesia. Email: surgery@emedsci.com What’s App: +1-947-333-4405