A COMPARISON OF TWO REGIMENS OF TRANEXAMIC ACID FOR REDUCING BLOOD LOSS IN LUMBAR SPINE FIXATION SURGERY: A RANDOMIZED COMPARATIVE TRIAL

Background: Spinal surgery may be associated with substantial blood loss requiring erythrocyte transfusion. Tranexamic acid has been used successfully in spinal fixation surgeries. Many regimens have been used either transfusion or infusion. In this study we compared the efficacy of two regimens in controlling perioperative blood loss in spinal fixation surgeries. Methods: In a prospective randomized trial, 40 patients, ASA I or II, (age 17-65 years) undergoing lumber fixation one or two levels were randomly assigned into one of two groups: Tranexamic acid infusion group (TI): patients received 10mg/kg TEA intravenously, then a maintenance infusion of 1mg/kg/h was continued until skin closure. Tranexamic acid bolus group (TB): patients received a single dose of 20mg/kg tranexamic acid intravenously. Hb and Hct values were recorded preoperatively and 24 hours postoperatively, intraoperative blood loss and the number of units of blood and the time of transfusion were recorded. Results: Hb and Hct values postoperative in group TI were significantly decreased (P value 0.048 and 0.024 respectively) compared to TB group. Blood loss (both preoperative and postoperative) and number of patients who received blood transfusion were less in tranexamic acid bolus group (TB) compared to tranexamic acid infusion group (TI). However this was not statistically significant. Conclusions: we concluded that the use of a single dose of 20mg/kg trariexamic acid intravenously in spine fixation surgery (2 levels) is an effective and easy applicable regimen in reducing perioperative blood loss and blood transfusion compared to 10mg/kg TEA intravenously, then a maintenance infusion of 1mg/kg/h.