Combined Use of Tranexamic Acid and Rivaroxaban in Posterior/Transforaminal Lumbar Interbody Fusion Surgeries Safely Reduces Blood Loss and Incidence of Thrombosis: Evidence From a Prospective, Randomized, Double-Blind, Placebo-Controlled Study. Issue 5 (June 2023)

• Record Type: Journal Article
• Authors: Li, Xiang; Jiao, Guangjun; Li, Jingyi; Ji, Weibin; Hao, Zhiwei; Gong, Fangli; Chen, Yunzhen
• Is Part Of: Global spine journal. Volume 13:Issue 5(2023)
• Page Start: 1229
• Page End: 1237
• Publication Date: 2023-06
• Subjects: tranexamic acid -- rivaroxaban -- lumbar surgery -- blood loss -- thrombosis -- safety; Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Abnormalities -- Periodicals; Spine -- Surgery -- Periodicals; 616.73
• DOI: 10.1177/21925682211024556
• Languages: English
• ISSNs: 2192-5682

Abstract

Study Design: A prospective, randomized, double-blind, placebo-controlled study. Objectives: There are few studies examining the balance between preventing venous thrombus embolism (VTE) and reducing blood loss in posterior/transforaminal lumbar interbody fusion (PLIF/TLIF) surgeries. This study aimed to evaluate the efficacy and safety of the combine application of TXA and rivaroxaban in patients undergoing PLIF/TLIF and explore relevant factors related to blood loss and VTE. Methods: Patients in group A which was the control group received 0.9% NaCl solution intravenously. Group B was treated by an intravenous injection of 2 g tranexamic acid (TXA) and the local use of 1 g intraoperatively. Group C was treated the same as group B intraoperatively, and they received 10 mg rivaroxaban qd treatment postoperatively. Eligible patients with an Autar score ≤ 10 were randomly assigned to group A or group B. Patients with an Autar score >10 were allocated into group C. Results: The intraoperative blood loss and postoperative drainage were lower in groups B and C than in group A ( P < .001). The blood transfusion rate in group B was lower than that in group A ( P < .001), while the incidence of VTE in group C was lower ( P < .001). Four factors were found to be positively correlated with obvious total blood loss ( P < .05). The data showed that 5 factors were correlated with the development of a thrombus ( P < .1). Conclusions: The combination of TXA and rivaroxaban in PLIF/TLIF patients is safe and effective in reducing D-dimer levels associated with VTE and reducing blood loss.