| Background:In recent years,theincidence of degenerative diseases of the lumbar spine has increased and clinical practice over the years has shown that PLIF/TLIF is an effective treatment for these conditions.The high intra-operative and postoperative blood loss is a problem that should not be overlooked.Significant blood loss can lead to metabolic acidosis,infection,hypotension and cardiac arrest.Blood transfusions can improve the anemia caused by surgery,but they are also associated with many complications,such as acute lung injury,allergic reactions,infectious diseases and postoperative infections.And as blood resources are very tight in China,it is essential to conserve valuable blood resources in the peri-operative period.With the advent of China’s ageing society,the number of elderly patients has increased,and the problem of high intra-operative and post-operative bleeding and high incidence of post-operative deep vein thrombosis in the lower limbs of this group of patients has become more prominent.It has become imperative to minimize intra-operative and postoperative blood loss and to avoid transfusion or reduce the amount of blood transfusion.This is also an important aspect of a series of optimization measures for peri-operative management since the concept of accelerated recovery surgery has gradually gained popularity.Objective:Few studies have examined the balance between preventing venous thromboembolism and reducing peri-operative blood loss.This study aims to address these issues,while exploring the associated risk factors that influence blood loss and venous thromboembolism.Methods:This study was a prospective cohort study that included cases from September 2019 to August 2020 at Qilu Hospital,Shandong University.Patients with a diagnosis of lumbar spinal stenosis,lumbar disc herniation or lumbar spondylolisthesis and proposed to undergo posterior approach lumbar fusion met the inclusion criteria.Patients were first scored on admission with an Autar score and grouped according to the results.Patients with a score of ≤10 were randomized to either the control group(Group A)or the tranexamic acid group(Group B),and those with a score of>10 were assigned to the tranexamic acid+rivaroxaban group(Group C).Patients in the control group received no special intrao-perative treatment and completed the surgery according to the previous surgical procedure;patients in group B received 2g of tranexamic acid intra-operatively and 1g topically intrao-peratively.Group C received the same intrao-perative treatment as group B and received 1 Omg of oral rivaroxaban daily for 35 days post-operatively.All patients were treated post-operatively with a lower limb pneumatic pump to prevent deep vein thrombosis.Pre-operative and post-operative hematological and demographic data,as well as pre-operative and post-operative venous ultrasound findings in both lower limbs,post-operative lumbar spine CT,number of blood transfusions(including autologous and allogeneic blood)and number of deep venous thrombosis were recorded.Conclusions were drawn by comparing the differences in the above data between the three groups.Results:A total of 657 eligible patients participated in the study.The intrao-perative blood loss and postoperative drainage were significantly lower in groups B and C than in group A(P<0.001).The autologous blood transfusion rate in group B was lower than that in group A(P<0.001),while the incidence of deep venous thrombosis in group C was significantly lower(P<0.001).Moreover,no adverse events were observed in this study.Six factors were found to be positively correlated with obvious total blood loss via Kendall’s tau-b correlation test(P<0.05).The data obtained by logistic regression showed that three factors were correlated with the development of a thrombus(P<0.1).Conclusions:The combined application of tranexamic acid and rivaroxaban in patients with PLIF/TLIF can improve patient safety by reducing the incidence of venous thrombosis and blood loss. |
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