Yunpeng Cui,1 Huaijin Li,2 Chuan Mi,1 Bing Wang,1 Yuanxing Pan,1 Wei Yu,3 Xuedong Shi1 

1Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Anesthesia, Peking University First Hospital, Beijing, People’s Republic of China; 3Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China

Correspondence: Xuedong Shi, Department of Orthopedic, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100032, People’s Republic of China, Email pku_ortho@163.com Wei Yu, Department of Urology, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100032, People’s Republic of China, Email yuweif@126.com

Background: To explore the effect of tranexamic acid (TXA) on perioperative blood loss in posterior decompression surgery of patient with metastatic spinal tumor.
Methods: Three hundred sixty-eight consecutive patients between May 2011 and Aug 2022 were retrospectively reviewed. One hundred eighty patients (182 surgeries) met the criteria and were included in the study. Sixty-two surgeries received preoperative intravenous TXA (TXA group), and 120 did not (non-TXA group). The primary outcome was total blood loss. T-test, Mann–Whitney U, and chi-square tests were used to evaluate the difference in baseline data, total blood loss, and other outcome measures between the two groups.
Results: Patients with hyper vascular tumors had significantly more blood loss compared with non-hyper vascular tumors (2002(1531,2792) mL vs 1469(1036,1962) mL, p=0.001). There was no significant different in the postoperative venous thromboembolism of the lower limb between the two groups. For patients with non-hyper vascular tumors, the blood loss (1216(827, 1709) mL vs 1561(1146, 2019) mL, p = 0.012) and postoperative drainage (1-day post-operation: 240(150,290) mL vs 280(150,395) mL, p=0.040; 3-days post-operation: 450(348,630) mL vs 613(398,799) mL, p=0.025) of TXA group were significantly less compared with that of the non-TXA group. Meanwhile, the TXA group had significantly less postoperative hospitalization compared with the non-TXA group (11.0(9.0, 13.3) days vs 12.5(9.0, 16.3) days, p=0.023). For patients with hyper vascular tumors, there were no significant differences in the blood loss and amount of postoperative drainage between the two groups.
Conclusion: Preoperative intravenous TXA demonstrated a trend toward decreased perioperative blood loss in posterior decompression surgery of spinal metastases with non-hyper vascular tumors.

Keywords: tranexamic acid, spinal metastases, blood loss, transfusion, blood supply