Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

Study Design: Nonrandomized, prospective, and case-controlled study. Purpose: To evaluate the efficacy and cost-effectiveness of topically applied tranexamic acid (TXA) during different phases of spine surgery. Overview of Literature: Perioperative blood loss is the leading cause of postoperative anemia associated with prolonged stays in hospital and long recovery times. The direct and indirect costs involved pose a significant economic challenge in developing countries. There is no consensus for topical use of tranexamic acid in spine surgery. Methods: Patients requiring a single-level TLIF were divided into two groups. In the TXA group (n=75), the wound surface was soaked with TXA (1 g in 100 mL saline solution) for 3 minutes after exposure, after decompression, and before wound closure, and in the control group (n=175) using only saline. Intraoperative blood loss drain volume was recorded on each of the first 2 days immediately after surgery. An estimated cost analysis was made on the basis of the length of hospital stay and the blood transfusion. Results: IBL for the control group was 783.33 +/- 332.71 mL and for intervention group 410.57 +/- 189.72 mL (p <0.001). The operative time for control group was 3.24 +/- 0.38 hours and for intervention group 2.99 +/- 0.79 hours (p <0.695). Hemovac drainage on days 1 and 2 for control group was 167.10 +/- 53.83 mL and 99.33 +/- 37.5 mL, respectively, and for intervention group 107.03 +/- 44.37 mL and 53.38 +/- 21.99 mL, respectively (p <0.001). The length of stay was significantly shorter in the intervention group (4.8 +/- 1.1 days) compared to control group (7.0 +/- 2.3 days). The cost of treatment in the intervention group was US dollar (USD) 4,552.57 +/- 1,222.6 compared with that in the control group USD 6,529.9 +/- 1,505.04. Conclusions: Topical TXA is a viable, cost-effective method of decreasing perioperative blood loss in major spine surgery with fewer overall complications than other methods. Further studies are required to find the ideal dosage and timing.