Effect of preoperative tranexamic acid on hidden blood loss and C-reactive protein in patients undergoing Delta-channel endoscopic lumbar discectomy: a retrospective case-control study.

BACKGROUND

The minimally invasive Delta-channel interlaminar endoscopic discectomy has been increasingly applied in clinical practice. However, the impact of tranexamic acid (TXA) on hidden blood loss (HBL) and C-reactive protein (CRP) levels in patients undergoing this procedure remains unclear. Accordingly, the present study is designed to investigate the impact of intravenous TXA on postoperative HBL and CRP levels in patients with lumbar disc herniation (LDH) treated via Delta-channel interlaminar endoscopic discectomy.

METHODS

A retrospective analysis was conducted on clinical data of 69 LDH patients who underwent Delta-channel interlaminar endoscopic discectomy between January 2023 and December 2024. Patients were divided into two groups. Of these, 25 patients who received intravenous infusion of 1 g TXA 15 min prior to skin incision were assigned to the observation group, whereas 44 patients who did not receive TXA were allocated to the control group. The following parameters were recorded as observation indicators, including operation time, intraoperative blood loss (IBL), HBL, postoperative activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), platelet count (PLT), D-dimer, CRP, hemoglobin (HB), red blood cell count (RBC), hematocrit (HCT), incision healing status, and the incidence of lower extremity deep vein thrombosis (DVT).

RESULTS

All surgeries were completed successfully, with all incisions achieving primary healing and no DVT events reported in either group. The HBL in the observation group was significantly lower than that in the control group, with a statistically significant difference (p < 0.05). There was no statistically significant difference between the two groups in terms of operation time, IBL, CRP, RBC, HB, HCT, APTT, PT, TT, FIB, PLT and D-dimer (p > 0.05). Univariate analysis revealed that TXA, TT, RBC, HB, and HCT were influencing factors for HBL. Further multivariate analysis identified TXA, TT, and HCT as independent predictors of HBL.

CONCLUSION

When treating LDH with Delta-channel interlaminar endoscopic discectomy, preoperative intravenous administration of TXA can effectively reduce HBL and serves as a protective factor against HBL. Meanwhile, it does not significantly affect postoperative CRP levels, indicating that it does not interfere with the clinical evaluation of postoperative inflammatory responses.