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Oral TXA may be beneficial in fusion surgery, more cost-effective than IV TXA
LOS ANGELES — There was greater reduction in blood loss and less hemoglobin drop in patients undergoing thoracolumbar fusion when they were administered oral tranexamic acid vs. IV tranexamic acid, according to results of a prospective randomized trial.
“Oral [tranexamic acid] TXA is a viable and more cost-effective alternative to IV TXA in preventing blood loss in spine surgery,” Charles C. Yu, MD, a fourth-year orthopedic surgery resident at Henry Ford Health System in Detroit, said at the North American Spine Society Annual Meeting.
After randomization and exclusions, there were 41 patients in the oral or PO group and 43 patients in the IV group. Patients in both groups, who Yu said were operated on by one of two senior surgeons, were essentially similar in terms of demographics, but 54% of the cases were revision surgeries. The PO group received 1.95 g PO TXA 2 hours preoperatively and the IV group received 2 g IV TXA given as 1 g before incision and 1 g before wound closure.
For the outcome measurements, hemoglobin drop was calculated as the difference between preoperative hemoglobin and the lowest hemoglobin recorded during each patient’s inpatient admission. Calculated blood loss was a function of patients’ estimated blood volume.
Yu said these measurements were the top two outcomes focused on in the study. When researchers analyzed them, he said, “both of these achieved statistical significance.”
Eight patients in the IV group and six patients in the PO group received blood transfusions.
Yu discussed cost benefits associated with PO TXA, saying “the IV form costs $50 to $100 per dose depending on the formulation and other factors. The oral form is both cheaper and easier to administer than the IV form.”
He said, “This is the first study looking at PO vs. IV in thoracolumbar fusions. Use of oral TXA could provide substantial savings to the health care system of at least $20 million per year.” – by Susan M. Rapp
Reference:
Yu CC. Paper 153. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.
Disclosure: Yu reports no relevant financial disclosures.