Intraoperative Tranexamic Acid Administration in Metastatic Spinal Tumor Surgery Does Not Result in Higher Rates of Thromboembolic Adverse Events

Introduction: TXA is frequently used in spine surgery to limit blood loss. However use in patients undergoing spinal column tumor resection, given their hypercoagulable state and systemic illness burden, necessitates further understanding with regards to safety profile and adverse effect of intraoperative TXA use.

Methods: Patient characteristics and complications including rates of deep vein thrombosis (DVT) and venous thromboembolism/pulmonary embolism (VTE/PE), were compared using univariate analysis between patients who did versus did not receive intraoperative TXA.

Results: 256 patients (39.8% female) with a mean age of 61.3 years were identified. 89 patients (34.8%) received intraoperative TXA. There were no significant differences between the TXA and non-TXA cohorts in age, sex, BMI, proportion of vascular (renal, thyroid, or hepatocellular) primary tumors (28.1% vs. 20.4%), and preoperative hemoglobin (Hgb) levels (11.8±2.0 vs 11.6±2.1)(p>0.05). The TXA cohort had higher rates of corpectomies (74.2% vs 57.5%, p=0.008), operated levels (7.4±2.5 vs 5.6±2.1, p< 0.001), intraoperative blood loss (1882±1767 vs. 776 ± 833 ml, p< 0.001), and transfusion rates (74.4% vs 44.3%, p< 0.001). The TXA and non-TXA cohorts did not differ significantly in rates of DVT (2.2% vs. 0.6%), VTE/PE (3.4% vs. 0.6%), 30-day (5.6% vs. 3.0%), and 90-day (7.9% vs. 4.2%) medical complications. The cohorts did not differ in rates of 30-day (3.4% vs. 2.4%) and 90-day (6.7% vs. 3.6%) surgical complications.

Conclusion : Intraoperative TXA administration in patients undergoing metastatic spinal column tumor resection did not result in higher rates of adverse events. Analysis of efficacy of TXA in reducing intraoperative blood loss and transfusions needs prospective, randomized trials given the heterogeneity of surgeries at baseline.