Safety of tranexamic acid in surgically treated isolated spine trauma

Wajiha Zahra; Sandeep Krishan Nayar; Ashwin Bhadresha; Vinay Jasani; Syed Aftab

doi:10.5312/wjo.v15.i4.346

Safety of tranexamic acid in surgically treated isolated spine trauma

World J Orthop. 2024 Apr 18;15(4):346-354. doi: 10.5312/wjo.v15.i4.346.

Authors

Wajiha Zahra¹, Sandeep Krishan Nayar², Ashwin Bhadresha², Vinay Jasani³, Syed Aftab⁴

Affiliations

¹ Trauma and Orthopedics Department, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom. wajiha.zahra@nhs.net.
² Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom.
³ Craniospinal Services, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom.
⁴ Spine Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom.

Abstract

Background: Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine trauma.

Aim: To assess the safety of TXA in isolated spine trauma. The primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion, respectively.

Methods: This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom.

Results: We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% vs 56%). All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min, compared with 24 patients (58%) in the non-TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 min. Among patients who received TXA, blood loss was < 150 and 150-300 mL in 8 (31%) and 15 (58%) patients, respectively. There were no cases of thromboembolic events in any patient who received TXA.

Conclusion: Our study demonstrated that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases. Further, larger studies are necessary to explore the rate, dosage, and mode of administration of TXA.

Keywords: Infection; Minimally invasive; Percutaneous; Thromboembolic disease; Tranexamic acid; Trauma.