Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2024; 15(4): 346-354
Published online Apr 18, 2024. doi: 10.5312/wjo.v15.i4.346
Safety of tranexamic acid in surgically treated isolated spine trauma
Wajiha Zahra, Sandeep Krishan Nayar, Ashwin Bhadresha, Vinay Jasani, Syed Aftab
Wajiha Zahra, Trauma and Orthopedics Department, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Sandeep Krishan Nayar, Ashwin Bhadresha, Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
Vinay Jasani, Craniospinal Services, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Syed Aftab, Spine Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
Author contributions: Zahra W, Nayar SK, and Bhadresha A contributed to data collection; Zahra W and Nayar SK contributed to data analysis; Jasani V and Aftab S contributed to supervision; Zahra W, Jasani V and Aftab S contributed to project idea; Zahra W contributed to writing the manuscript and literature review; Nayar SK contributed to review the manuscript; Jasani V and Aftab S contributed to overall supervision.
Institutional review board statement: The project is reviewed and registered with the audit registration team of Royal Stoke University Hospital (No: CA44/21).
Informed consent statement: Informed written consent was obtained from the patients.
Conflict-of-interest statement: We certify that there is no conflict of interest related to the manuscript.
Data sharing statement: Consent was not obtained but the presented data are anonymized.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wajiha Zahra, MBBS, MSc, MRCS, Specialty Registrar Trauma & Orthopedics, University Hospital of North Midlands NHS Trust, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom. wajiha.zahra@nhs.net
Received: November 10, 2023
Peer-review started: November 10, 2023
First decision: January 12, 2024
Revised: February 7, 2024
Accepted: March 19, 2024
Article in press: March 19, 2024
Published online: April 18, 2024
Processing time: 157 Days and 8.9 Hours
Abstract
BACKGROUND

Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine trauma.

AIM

To assess the safety of TXA in isolated spine trauma. The primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion, respectively.

METHODS

This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom.

RESULTS

We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% vs 56%). All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min, compared with 24 patients (58%) in the non-TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 min. Among patients who received TXA, blood loss was < 150 and 150–300 mL in 8 (31%) and 15 (58%) patients, respectively. There were no cases of thromboembolic events in any patient who received TXA.

CONCLUSION

Our study demonstrated that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases. Further, larger studies are necessary to explore the rate, dosage, and mode of administration of TXA.

Keywords: Tranexamic acid; Infection; Trauma; Thromboembolic disease; Minimally invasive; Percutaneous

Core Tip: Since the introduction of tranexamic acid (TXA), it has been used for reducing blood loss in various surgical specialties such as Urology, general surgery, trauma and orthopedics. TXA use for elective spine surgery is well documented but there is scarce literature to explain the safety of TXA in isolated whole spine trauma. This study looks at the clinical practice of spine surgeons in two major United Kingdom trauma centres and explore the safety of TXA. The study sets the foundation for future research with larger number of patients and to improve the clinical practice.