Effect of local application of tranexamic acid on coagulation and fibrinolysis in patients undergoing spinal surgery / 解放军医学杂志

ABSTRACT

Objective To investigate the effect of tranexamic acid (TXA) on blood coagulation and fibrinolysis in patients undergoing spinal surgery. Methods From October 2017 to October 2018, 96 patients, who underwent multi-segment, thoracolumbar posterior bone graft fusion and internal fixation in the Spinal Surgery Department of Daping Hospital, Army Medical University, were selected and randomly divided into 4 groups (24 each) control group (flushing incision with normal saline), intravenous drip group (intravenous drip of 1% TXA injection), 0.5% TXA group (0.5% TXA injection applied on the incision) and 1% TXA group (1% TXA injection applied on the incision). The incision drainage of each group was measured on the 1st, 2nd and 3rd day after operation, the five indicators of coagulation [activated partial prothrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and International standardized ratio (INR)] were measured before operation and the 1st, 2nd and 3rd day after operation. The level of D-dimer (D-D) was determined by immunoturbidimetry. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) were detected by ELISA. The maximum thrombus amplitude (MA), reaction time (R), coagulation time (K), coagulation angle (Angle) and fibrinolytic activity value (LY30) were measured by the thrombus elastic diagram (TEG). Finally, double lower limb B-ultrasonography was performed 1 day before discharge. B-ultrasound examination of lower extremities was performed one day before discharge. Results On the 1st, 2nd and 3rd day after surgery, the drainage volume was less in intravenous drip group, 0.5% TXA group and 1% TXA group than in the control group in the same period (P0.05). On the 1st, 2nd and 3rd day after surgery, the D-D level was lower in intravenous drip group, 0.5% TXA group and 1% TXA group than in the control group (P0.05). On the first day after surgery, MA was higher in intravenous drip group, 0.5% TXA group and 1% TXA group than in the control group (P0.05). No significant difference existed in R, K, Angle and LY30 among the 4 groups and within the same group between different time points (P>0.05). B-ultrasound showed no deep venous thrombosis in both lower limbs one day before discharge. Conclusion Local application of TXA with same dosage in spinal surgery may play a better antifibrinolytic and hemostatic effect than intravenous application of TXA.