AANA February 2023 Journal Course: The Administration of Tranexamic Acid for Complex Spine Surgery-Article

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Complex spine surgeries often result in significant perioperative blood loss, which may require blood transfusion. However, blood transfusions can lead to complications and increased morbidity and mortality. To minimize blood loss, antifibrinolytic medications such as tranexamic acid (TXA) have been used prophylactically in various surgical procedures. TXA is a synthetic amino acid that inhibits fibrinolysis, promoting hemostasis. It can be administered orally, topically, or intravenously.<br /><br />In complex spine surgeries, the use of TXA is becoming increasingly popular. However, there is still no consensus on the optimal dosing regimen. Recent studies have shown that high-dose TXA is associated with decreased blood loss, transfusion requirements, and hospital length of stay compared to low-dose regimens, without an increase in adverse effects.<br /><br />There are certain absolute contraindications to the use of TXA, including a history of anaphylactic reaction, active coagulopathy, renal failure, acute subarachnoid hemorrhage, and recent pulmonary embolism, deep vein thrombosis, or coronary stenting. Relative contraindications include renal dysfunction, preexisting coagulopathy or anticoagulation treatment, uncontrolled seizure disorder, and increased risk of venous thromboembolism.<br /><br />Special consideration should be given to patients with a history of hypercoagulability, seizures, hypersensitivity, and renal disease. Dosing adjustments may be necessary for patients with chronic renal disease. Topical TXA can be considered for patients who cannot receive intravenous TXA.<br /><br />In conclusion, TXA is an effective and safe medication for minimizing blood loss in complex spine surgeries. High-dose regimens have shown superior efficacy, but further research is needed to establish standardized dosing guidelines. The use of topical TXA and combined therapy with both topical and systemic administration may also be beneficial.

Keywords

complex spine surgeries

perioperative blood loss

blood transfusion

antifibrinolytic medications

tranexamic acid

TXA

fibrinolysis inhibition

high-dose TXA

contraindications to TXA

topical TXA