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.