Adjunctive Topical Tranexamic Acid for Blood Salvage Does Not Reduce Postoperative Blood Loss Compared With Placebo in Patients Who Undergo Palliative Decompressive Spinal Metastasis Surgery: A Randomized Controlled Trial
Adjunctive Topical Tranexamic Acid for Blood Salvage Does Not Reduce Postoperative Blood Loss Compared With Placebo in Patients Who Undergo Palliative Decompressive Spinal Metastasis Surgery: A Randomized Controlled Trial
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与安慰剂相比，接受姑息性脊柱转移瘤减压手术的患者辅助局部用氨甲环酸进行血液挽救并不能减少术后失血：一项随机对照试验
DOI：
10.1097/brs.0000000000004280
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Sangsin A
中科院分区：
文献类型：
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作者：
Maethungkul R;Atthakomol P;Phinyo P;Phanphaisarn A;Murakami H;Sangsin A
研究设计。目的：评价外用氨甲环酸（tTXA）对恶性硬膜外脊髓压迫行姑息性脊髓转移减压手术患者减少术后出血量和填充红细胞（PRC）输血的疗效。背景资料摘要。姑息性减压脊柱转移手术与术后大量失血和输血率增加有关。tTXA减少创伤性或退行性脊柱手术的失血量；方法：本研究共纳入65例行姑息性胸腰椎转移减压手术的患者。在33例患者中，将1g tTXA （20ml）浸泡在可吸收的明胶海绵中，并放置在减压部位外侧。对照组的其余32名患者接受同样的治疗，用相同体积的生理盐水代替TXA。所有患者在手术开始前都接受了标准的1g静脉注射TXA。结果：tTXA组与安慰剂组术后出血量无显著差异（P50 778 mL [IQR 347, 1,122 mL] vs P50 490 mL [IQR 295, 920 mL]， P= 0.238）。tTXA组和安慰剂组术后需要PRC输血的患者数量非常相似（15例[45.45%]对16例[50%]；P= 0.585）。结论我们不推荐tTXA作为减压性脊柱转移手术患者的辅助治疗，因为它对预防性静脉注射TXA在术后出血量和输血率方面没有额外的好处。目前的研究旨在评估辅助外用氨甲环酸（tTXA）在减少姑息性脊柱转移手术患者术后失血和异体输血方面的疗效。辅助tTXA与标准预防性静脉注射途径相比，在血液回收和输血率方面没有额外的益处。
Study Design.Randomized controlled trial.Objective.To evaluate the efficacy of adjunctive topical tranexamic acid (tTXA) in reducing postoperative blood loss and packed red cell (PRC) transfusion in patients who underwent palliative decompressive spinal metastasis surgery for malignant epidural spinal cord compression.Summary of Background Data.Palliative decompressive spinal metastasis surgery is associated with massive postoperative blood loss and increased transfusion rate. tTXA reduces blood loss in traumatic or degenerative spinal surgery; however, the role of topical TXA in decompressive spinal metastasis surgery remains controversial.Method.A total of 65 patients who underwent palliative decompressive thoracolumbar spinal metastasis surgery were included in this study. In 33 patients, 1 g of tTXA (20 mL) was soaked in an absorbable gelatin sponge and placed lateral to the decompressive site. The remaining 32 patients in the control group received the same procedures with normal saline at the same volume, instead of TXA. All of the patients received standard 1 g intravenous TXA, just before initiating the operation. The primary outcome was postoperative blood loss, and the secondary outcomes were postoperative PRC transfusion and complications.Results.No differences were found in postoperative blood loss between tTXA and placebo group (P50 778 mL [IQR 347, 1,122 mL] versus P50 490 mL [IQR 295, 920 mL]; P= 0.238). The number of patients requiring postoperative PRC transfusion were quite similar in tTXA and placebo groups (PRC transfusion in 15 patients [45.45%] versus 16 patients [50%]; P= 0.585). No complications related to TXA and absorbable gelatin sponge were observed.Conclusion.We do not recommend tTXA as an adjunctive treatment for patients undergoing decompressive spinal metastasis surgery since it does not provide additional benefit to prophylactic intravenous TXA in postoperative blood loss and transfusion rate.Level of Evidence: 2The current study was aimed at evaluating the efficacy of adjunctive topical tranexamic acid (tTXA) in reducing postoperative blood loss and allogenic blood transfusion in patients undergoing palliative spinal metastasis surgery. No additional benefit of adjunctive tTXA to standard prophylactic intravenous route for blood salvage and transfusion rate.