Tranexamic Acid in Thoracic and Lumbar Fusions and Perioperative Blood Loss

Nathan Wanderman, William Robinson, Bayard Carlson, Mohamad Bydon, Brad Currier, Paul Huddleston, Ahmad Nassr, Brett Freedman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Study Design:This study was a retrospective cohort design.Objective:The objective of this study was to examine the impact of tranexamic acid (TXA) on total perioperative wound output following thoracic and lumbar spinal fusions.Summary of Background Data:TXA has been extensively studied with regard to intraoperative blood loss and transfusion rates. Few studies have looked specifically at the effect of TXA on postoperative drain output.Materials and Methods:We examined blood loss patterns in 617 consecutive adult patients undergoing lumbar and/or thoracic fusions at a single institution from January 2009 to 2016. These patients were divided into TXA and non-TXA, as well as high-dose and low-dose TXA, groups and analyzed using a propensity score to account for differences between cohorts.Results:The TXA and non-TXA groups were demographically similar. The mean number of levels fused was higher in the TXA group (4.8 vs. 3.1 levels, P<0.01). There was a significant reduction in both intraoperative blood loss (77.7 mL per level, P=0.020) and postoperative drain output (83.3 mL per level, P=0.002) in the TXA group when examined on a per level fused basis, but no significant difference without controlling for a number of levels. Postoperative blood loss tended to be higher in the TXA group for surgeries involving >5 levels fused. There was a significantly less blood loss in the high-dose TKA group both intraoperatively (296.4 mL per level fused, P<0.001) and postoperatively (133.4 mL per level fused, P<0.001).Conclusions:TXA significantly reduced both intraoperative and postoperative blood loss in lumbar and thoracic fusions when examined on a per level basis. However, with surgeries involving fusions >5 levels, TXA may increase postoperative drain output, with those losses offset by reduced intraoperative blood loss. High-dose TXA further reduced both intraoperative and postoperative blood loss as compared with low-dose TXA.

Original languageEnglish (US)
Pages (from-to)E462-E468
JournalClinical Spine Surgery
Issue number10
StatePublished - Dec 1 2019


  • blood loss
  • lumbar fusion
  • subfacial drain
  • thoracic fusion
  • tranexamic acid

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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