Two Doses of Tranexamic Acid Reduce Blood Transfusion in Complex Spine
Surgery: A Prospective Randomized Study
Raksakietisak M, Sathitkarnmanee B, Srisaen P, Duangrat T, Chinachoti T, Rushatamukayanunt
P, Sakulpacharoen N
Spine. 2015 Dec; 40( 24):E1257-63. PubMed ID: 26208230 Available at: https://www.ncbi.nlm.nih.
Study Design: Prospective, double-blinded, randomized controlled study.
Objective: To determine whether the use of 2 doses of tranexamic acid ( TXA) can reduce
perioperative blood loss and blood transfusions in low-risk adult patients undergoing
Summary of Background Data: Complex laminectomy (multilevel laminectomy or laminectomy and instrumentation) is a procedure with a medium risk of blood loss, which
may require allogeneic blood transfusion. Previous studies of TXA showed its inconsistent
effectiveness in reducing blood loss during spine surgery. The negative results may stem
from ineffective use of a single dose of TXA during long and complex operations.
Methods: 80 adult (18–65 yr old) patients in Siriraj Hospital, Mahidol University, Thailand were enrolled and allocated into 2 groups ( 40 patients in each group) by computer-generated randomization. Patients with history of thromboembolic diseases were excluded. Anesthesiologists in charge and patients were blinded. Group I received 0.9%
NaCl (NSS) or placebo and group II received 2 doses ( 15 mg/kg) of TXA. The first dose
was administered before anesthesia induction and the second dose, after 3 hours. The
assessed outcomes were the amount of perioperative blood loss and the incidence of
Results: 78 patients were analyzed ( 1 patient in each group was excluded) with 39 patients
randomized to each group. There were no differences in patient demographics and pre
and postoperative hematocrit levels. The total blood loss in the control group (NSS) was
higher [900 (160, 4150) mL] than in the TXA group [600 (200, 4750) mL]. Patients in the
control group received more crystalloid, colloid, and packed red blood cell transfusions.
Within 24 hours, we observed a 64.6% reduction of blood transfusions ( 43.5% vs. 15.4%,
P¼0.006). No serious thromboembolic complications occurred.
Conclusion: 2 effective doses ( 15 mg/kg) of TXA can reduce blood loss and transfusions
in low-risk adults undergoing complex spine surgery.
Reprinted with permission.
Raksakietisak et al evaluated whether two doses of perioperative tranexamic acid (TXA)
would reduce blood loss and blood transfusions in adult patients undergoing complex
thoracolumbar surgeries. The authors performed a prospective, blinded, randomized
controlled trial at Siriraj Hospital in Bangkok, Thailand between May 2012 and December
2013. The study included low-risk patients (ages 18-65 years old) with American Society
of Anesthesiologists (ASA) physical statuses 1 to 3. The operations included: multilevel
laminectomy (three or more levels), laminectomy with instrumentation, laminectomy
with instrumentation with PLIF or TLIF or osteotomy, posterior spinal fusion for scoliosis
and laminectomy for tumor removal.
Raj J. Gala, MD; Jonathan N.
Department of Orthopaedics and
Rehabilitation, Yale University
School of Medicine
New Haven, CT, USA