Tranexamic Acid and Major Spine Surgery Trends and Controversies
The beneficial role and efficacy of Tranexamic Acid in reducing perioperative blood loss and blood transfusion equirements in spine surgery is being established. Tranexamic Acid is an anti fibrinolytic agent traditionally used tolessen perioperative blood loss. Tranexamic Acid can be administered orally, intramuscularly, intravenously ortopically. Tranexamic Acid studies in spine surgery have limited patient enrolment. Most of the reported studies have mixed results and difficult to interpret. The efficacy of anti fibrinolytic agents is evident in a wide variety of surgicalprocedures: liver transplantation, obstetrics and gynaecology, trauma and orthopaedic surgical procedures. The effect of Tranexamic Acid on the occurrence of thromboembolic events, strokes, myocardial ischemia, seizures and mortality has not been adequately assessed and remains uncertain. A number of possible complications reported. In this review, we analyze the efficacy and safety profile of perioperative Tranexamic Acid with the exclusion of cardiac surgery and a focus on major spinal surgery
Excessive bleeding often complicates spine surgery. This may result in increased morbidity and mortality. The amount of blood loss depends on many factors. The extent of a surgical procedure is the principal cause of a blood loss during spine surgery. Perioperative coagulation dysfunction is also an important factor leading to an excessive blood loss during lengthy spinal surgeries. Tranexamic Acid (TA) is safely used for the prevention of blood transfusion for majorjoint replacement procedures. The benefit and safety oftranexamic TA in patients undergoing major spinal fusion is not completely established. Nevertheless, TA appears to have a potential role in the management of spinal surgery. Identifying patients at riskplays paramount importance in preventing excessive blood loss [5,6].The role of a surgeon cannot be overestimated. Optimal positioning tominimize epidural venous bleeding, including intraoperativenormovolemic hemodilution, cell salvaging, minimization of a surgical invasiveness, staging of a procedure and administration of variousantifibrinolytic agents is utilized with various success to lessenperioperative blood loss in patients undergoing spine surgery. What method is the most effective, safest or advantageous remains unclear.
Antifibrinolytic agents, including TA, could be valuable adjuncts toperioperative hemorrhage management. TA is a widely used antifibrinolytic agent. The beneficial role and efficacy of TA in reducing perioperative blood loss and need for blood transfusion is evident. TAis administered orally, intramuscularly, intravenously or topically for a wide variety of surgical procedures. The efficacy of anti fibrinolyticagents is described in a wide variety of surgical procedures: liver transplantation, obstetrics and gynecology, trauma and orthopaedic surgical procedures. Bleeding often complicates spine surgery. This results in increased morbidity and mortality. The extent of a surgical procedure is the principal cause of a blood loss.
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