Safety and effectiveness of intravenous tranexamic acid for posterior lumbar interbody fusion in patients on preoperative anticoagulants: a retrospective case-control study.

BACKGROUND

Tranexamic acid (TXA) is a hemostatic agent used in posterior lumbar interbody fusion (PLIF). However, reports on its use in patients on preoperative anticoagulants are scarce. This study evaluates the safety and efficacy of preoperative 1 g TXA in such patients.

METHODS

This study retrospectively analyzed the medical records of patients who underwent PLIF and had received anticoagulants within 1 week before surgery between January 2021 and June 2023. After general anesthesia, at 15 min before skin incision, patients who received intravenous TXA were recorded as the observation group (n = 31), and those who did not were recorded as the control group (n = 29). The main observation indicators included surgical time, intraoperative blood loss (IBL), postoperative drainage volume (PDV), number of blood transfusions, red blood cell count (RBC), hemoglobin (HB), and hematocrit (HCT) on the postoperative 1st, 4th, 7th, and last-test days. The secondary observation indicators included postoperative incision healing, number of lower limb deep vein thrombosis (DVT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), platelet count (PLT) and postoperative hospital stay.

RESULTS

The surgeries were successfully completed. The incisions healed as grade A, and no DVT occurred. The IBL and PDV in the observation group were significantly lower than those in the control group (p < 0.05). There were no significant differences between the two groups in surgical time or blood transfusions (p > 0.05). The multivariate linear regression analysis revealed that the surgical segment and TXA were independent influencing factors for IBL and PDV, while age, body mass index, gender, coexisting hypertension, disease type, and anticoagulant type were not. Subgroup multivariate analysis further confirmed that anticoagulant type was not an independent influencing factor of IBL or PDV. There were no statistically significant differences between the two groups in RBC, HB, or HCT at any postoperative time point (p > 0.05). There was no significant difference in postoperative PT, APTT, TT, FIB, PLT, or postoperative hospital stay between the two groups (p > 0.05).

CONCLUSION

For patients undergoing PLIF with preoperative anticoagulation, TXA administration appears safe and significantly reduces perioperative blood loss.