[Hemostatic efficacy of tranexamic acid combined with absorbable fluid hemostat in single-level transforaminal lumbar interbody fusion during the perioperative period].

OBJECTIVE: To compare the effect of intravenous tranexamic acid (TXA) combined with local application of gelatin sponge versus intravenous TXA combined with absorbable fluid hemostat(SurgifloTM) on perioperative blood loss in patients undergoing single-level transforaminal lumbar interbody fusion (TLIF).

METHODS: A retrospective analysis was conducted on the clinical data of 64 patients undergoing single-segment TLIF between September 2023 and September 2024. The control group comprised 32 patients who received intravenous TXA infusion combined with local gelatin sponge hemostasis during the perioperative period, including 14 males and 18 females, aged 49 to 70 years with a mean of (60.47±5.93) years. The affected segments were as follows:L2,3 in 1 case, L3,4 in 6 cases, L4,5 in 13 cases, and L5S1 in 12 cases. The observation group consisted of 32 patients receiving intravenous TXA infusion combined with local SurgifloTM hemostasis, including 15 males and 17 females, aged 49 to 69 years with a mean of (59.59±5.35) years. The affected segments were:L2,3 in 1 case, L3,4 in 7 cases, L4,5 in 12 cases, and L5S1 in 12 cases. Compare and observe the preoperative and postoperative changes in hematocrit (HCT) and hemoglobin (HGB) levels between the two groups;the total blood volume, intraoperative blood loss, total postoperative drainage volume, perioperative total blood loss, extubation time, and operative duration were compared between the two groups.

RESULTS: All patients were followed up, and the duration ranged from 2 to 3 months, with a mean of (2.10±0.57) months. The observation group showed significantly higher HCT levels at postoperative days 1 and 3, and higher HGB levels at postoperative day 3 compared to the control group (all P<0.05). The intraoperative blood loss in the observation group was (230.16±22.98) mL, significantly lower than that in the control group (250.63±22.09) mL, with a statistically significant difference (P<0.05). The observation group exhibited significantly lower perioperative total blood loss (907.29±270.13) mL and postoperative drainage volume (199.06±19.49) mL compared to the control group (1 166.73±269.13) mL and (211.19±20.75) mL, respectively, with statistically significant differences (P<0.05). The extubation time (2.56±0.50) days and operative duration (161.25±14.87) minutes in the observation group were significantly shorter than those in the control group (3.03±0.65) days and (172.50±15.24) minutes, respectively, with a statistically significant difference (P<0.05). Multiple linear regression analysis identified the use of SurgifloTM as the most significant predictor of reduced total perioperative blood loss (β=-0.550, P<0.001).

CONCLUSION: Compared with the combination of intravenous TXA and gelatin sponge, the use of intravenous TXA combined with local SurgifloTM in single-level TLIF significantly reduces postoperative drainage and perioperative blood loss, shortens both operation time and extubation time, without increasing the risk of wound complications or deep vein thrombosis.