Intravenous Tranexamic Acid is Associated with an Increased Incidence of Thromboembolic Events in High-Risk Patients Undergoing Instrumented Multilevel Thoracolumbar Fusions
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Abstract
Study Design: Retrospective cohort study.
Objective: Tranexamic acid (TXA) is increasingly being used to assist in perioperative hemostasis for patients undergoing orthopedic surgery. Though TXA has been shown to be safe in the general population, there is little literature on its safety profile patients undergoing multilevel spine surgery who are high-risk because of a personal history of a thromboembolic event. In this context, we sought to directly evaluate complications in high-risk patients undergoing multilevel thoracolumbar fusion who received TXA.
Methods: In this retrospective cohort study, we identified high-risk patients, defined as those with a history of deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, or stroke who underwent posterior thoracic or lumbar instrumented spinal fusion of ≥3 levels. Patients were separated into two groups based on receipt of TXA during their surgical care. The primary outcome was a composite of DVT or PE in the perioperative period.
Results: A total of 113 patients were included, 16 of whom received TXA. The TXA cohort had a higher number of vertebral levels treated, longer operative time, and greater intraoperative blood loss/transfusion requirement. The DVT/PE rate in the TXA cohort was 18.8% compared to 4.1% in the non-TXA cohort. Multivariable regression analysis to adjust for operative levels demonstrated a statistically elevated odds of developing a DVT/PE in patients who received TXA compared to those who did not (OR 9.1 95% CI 1.04 – 75.4, p = 0.046).
Conclusions: High-risk patients who underwent multilevel thoracolumbar fusion and who received TXA were at increased odds of developing a postoperative DVT/PE compared to those who did not. We suggest replicating this study methodology in a setting with access to larger representative cohorts, such that additional covariates can adequately be adjusted against.
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References
2. Clay TB, Lawal AS, Wright TW, et al. Tranexamic acid use is associated with lower transfusion rates in shoulder arthroplasty patients with preoperative anaemia. Shoulder Elbow. 2020; 12(1 Suppl):61-69.
3. Belk JW, McCarty EC, Houck DA, Dragoo JL, Savoie FH, Thon SG. Tranexamic Acid Use in Knee and Shoulder Arthroscopy Leads to Improved Outcomes and Fewer Hemarthrosis-Related Complications: A Systematic Review of Level I and II Studies. Arthroscopy. 2021;37(4):1323-1333.
4. Zhu X, Shi Q, Li D, et al. Two Doses of Tranexamic Acid Reduce Blood Loss in Primary Posterior Lumbar Fusion Surgery: A Randomized-controlled Trial. Clin Spine Surg. 2020;33(10):E593-E597.
5. Ko BS, Cho KJ, Kim YT, Park JW, Kim NC. Does Tranexamic Acid Increase the Incidence of Thromboembolism After Spinal Fusion Surgery? Clin Spine Surg. 2020;33(2):E71-E75.
6. Theusinger OM, Spahn DR. Perioperative blood conservation strategies for major spine surgery. Best practice & research Clinical anaesthesiology. 2016;30(1):41-52.
7. Liu ZG, Yang F, Zhu YH, Liu GC, Zhu QS, Zhang BY. Is TXA beneficial in open spine surgery? And its effects vary by dosage, age, sites, and locations: A meta-analysis of randomized controlled trials. World Neurosurg. 2022.
8. Porter SB, Spaulding AC, Duncan CM, Wilke BK, Pagnano MW, Abdel MP. Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Hip Fracture Undergoing Arthroplasty. J Bone Joint Surg Am. 2021;103 (20):1880-1889.
9. Porter SB, White LJ, Osagiede O, Robards CB, Spaulding AC. Tranexamic Acid Administration Is Not Associated With an Increase in Complications in High-Risk Patients Undergoing Primary Total Knee or Total Hip Arthroplasty: A Retrospective Case-Control Study of 38,220 Patients. J Arthroplasty. 2020;35(1):45-51 e43.
10. Porter SB, Spaulding AC, Duncan CM, Wilke BK, Pagnano MW, Abdel MP. Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Intertrochanteric Fracture. J Bone Joint Surg Am. 2022;104(13):1138-1147.
11. Myles PS, Smith JA, Forbes A, et al. Tranexamic acid in patients undergoing coronary-artery surgery. New England Journal of Medicine. 2017;376(2):136-148.
12. Yu S, Ma Y, Gronsbell J, et al. Enabling phenotypic big data with PheNorm. J Am Med Inform Assoc. 2018;25(1):54-60.
13. Shi P, Wang J, Cai T, et al. Safety and Efficacy of Topical Administration of Tranexamic Acid in High-Risk Patients Undergoing Posterior Lumbar Interbody Fusion Surgery. World Neurosurg. 2021; 151:e621-e629.