A Prospective Study On The Effectiveness And Safety Of Different Administration Methods Of Tranexamic Acid In Reducing Blood Loss During Posterior Lumbar Interbody

Objective:To investigate the safety and efficacy of different methods of tranexamic acid in elderly patients with 2-level posterior lumbar interbody fusion for hemostasis.To observe the prospective study of intravenous drip and local soaking of tranexamic acid on reducing blood loss after spinal surgery,and provide theoretical guidance for clinical application of tranexamic acid.Methods: A total of 90 patients with lumbar degenerative diseases who were admitted to the Department of Orthopaedics,Affiliated Hospital of Inner Mongolia Medical University from December 2020 to December 2021 and required elective lumbar 2-level posterior lumbar interbody fusion were selected.After strict screening of patients according to the inclusion and exclusion criteria,a total of 85 patients were included in our study.According to the use of tranexamic acid and the order of patients’ admission,they were randomly divided into 3 groups,namely the intravenous drip group(29 patients),the local infiltration group(28 patients)and the control group(28 patients).The intravenous drip group was given 20mg/kg tranexamic acid intravenously at the time of skin incision and slowly until the end of surgery.The local infiltration group used 100ml:1g of tranexamic acid solution to locally soak the surgical site for about 5 minutes before the suture at the end of the operation;the control group was not intervened.SPSS 24.0was used to compare the general data(gender,age and BMI),average operation time,intraoperative blood loss,drainage volume in 24 hours after operation,hidden blood loss from intraoperative to 24 hours after operation and total blood loss among the three groups of patients.Blood loss,blood transfusion cases and postoperative complications were monitored and recorded.Hemoglobin,hematocrit,coagulation function and fibrinolysis indexes were monitored and recorded before and 24 hours after surgery.Results:Intraoperative blood loss,hidden blood loss and total blood loss in the intravenous infusion group were significantly lower than those in the local infiltration group and the control group,the differences were statistically significant(P<0.01),while the differences between the control group and the local infiltration group were not significant(P>0.05).The 24 h postoperative drainage volume in the intravenous infusion group was significantly lower than that in the control group,and the difference was statistically significant(P<0.01).The difference between the local infiltration group and the control group was also significant(P<0.05),while the difference between the intravenous infusion group and the local infiltration group was insignificant(P>0.05).There were no significant differences in general data,preoperative and postoperative coagulation function indexes,D-dimer,fibrinogen,preoperative hemoglobin,hematocrit and fibrinogen degradation products among 3groups(P>0.05).The hemoglobin and hematocrit values of the intravenous infusion group were higher than those of the local infiltration group and the control group,indicating statistically significant differences(P<0.05),while the differences between the control group and the local infiltration group were insignificant(P>0.05).The fibrinogen degradation products in the intravenous drip group and the local infiltration group were less than those in the control group 24 h after surgery,indicating statistically significant differences(P<0.05),while the differences between the intravenous drip group and the local infiltration group were insignificant(P>0.05).The average duration of surgery and the number of cases of blood transfusion in the intravenous infusion group were less than those in the local infiltration group and the control group,indicating statistically significant differences(P<0.05),while the differences between the local infiltration group and the control group were not significant(P>0.05).All patients in the three groups underwent color doppler ultrasound examination of lower limbs before and 1 week after surgery,and no deep venous thrombosis occurred.No adverse reactions,such as deep vein thrombosis,epilepsy,pulmonary embolism or allergy,occurred in the patients in outpatient re-evaluation or telephone follow-up 3 and 6 months after the operation.Conclusion: Although local immersion of tranexamic acid can effectively and safely reduce the drainage volume of elderly patients with 2-level posterior lumbar interbody fusion at 24 hours after surgery,its overall effect on reducing perioperative blood loss is not obvious.In contrast,intraoperative intravenous tranexamic acid was more effective in reducing perioperative blood loss in elderly patients with 2-level posterior lumbar interbody fusion,and did not significantly increase the risk of thromboembolism.