Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Vertebra Cerrahisinde İntraoperatif Yüksek Doz Traneksamik Asit İnfüzyonu: Klinik Deneyimlerimiz
Intraoperative High-Dose Tranexamic Acid Infusion in Vertebral Surgeries: Our Clinical Experiences
Öznur DEMİROLUKa, Ceren KÖKSALa, Ahmet Onur AKPOLATb, Mehmet Bülent BALİOĞLUb, Dilek ERDOĞAN ARIa
aDepartment of Anesthesiology and Reanimation, University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, İstanbul, TURKEY
bDepartment of Orthopaedic Surgery, University of Health Sciences Fatih Sultan Mehmet Health Research and Training Center, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2020;40(3):277-84
doi: 10.5336/medsci.2020-73734
Article Language: EN
Full Text
ABSTRACT
 Objective: We aimed to share our experiences on perioperative blood loss and the prevalence of side effects of high-dose tranexamic acid (TXA) used intraoperatively in vertebral surgeries. Material and Method: Thirty-four patients with the class of American Society of Anaesthesiology(ASA) I'III who underwent posterior spinal instrumentation and osteotomy at ≥5 vertebral levels were retrospectively analysed. TXA was administered intravenously from beginning to end of surgery at a loading dose of 50 mg/kg and a maintenance dose of 10 mg/kg/h. In addition to routine monitoring, minimal invasive cardiac output measurement was also used. Operative parameters, intraoperative-postoperative blood loss, mean volume of blood transfusion and fluids, hospitalization time, Hb, BUN, creatinine, Plt, INR levels, side effects and complications were recorded and evaluated. Results: Median value of fused spinal segments was 12 (7-13). Intraoperative blood loss was 1448.53±767.18 ml, 133.85±61.77 ml per fused spinal segment and 172.79±82.12 ml per hour during the operation. While intraoperative blood loss was significantly lower in patients undergoing primary surgery than in revision patients, there was no difference in terms of postoperative blood loss. It was directly correlated with the number of fused vertebrae, duration of surgery, age and ASA. Mean amount of red blood cell transfused was 1.5±1.29U. There were no significant complications or side effects such as thromboembolism, seizure or renal failure in our patients. Conclusion: Although appropriate dosages are not yet established, we think that a loading dose of 50 mg/kg TXA can be used safely in vertebral surgeries without causing significant side effects.

Keywords: Tranexamic acid; scoliosis; spinal fusion; blood loss, surgical; antifibrinolytic agents
ÖZET
 Amaç: Vertebra ameliyatlarında intraoperatif olarak kullanılan yüksek dozda traneksamik asitin (TXA) perioperatif kan kaybı ve yan etkilerin yaygınlığı konusundaki deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntemler: Amerikan Anesteziyoloji Derneği (ASA) I-III, ≥5 seviye posterior spinal enstrümantasyon ve osteotomi uygulanmış, 34 hasta retrospektif olarak incelendi. TXA 50 mg/kg yükleme ve 10 mg/kg/saat idame dozda cerrahi başından sonuna kadar intravenöz olarak uygulanmıştı. Rutin monitörizasyona ek olarak minimal invaziv kardiyak output ölçümü de kullanıldı. Ameliyat parametreleri, intraoperatif-postoperatif kan kaybı, ortalama kan transfüzyonu ve sıvı hacmi, hastanede yatış süresi, Hb, BUN, kreatinin, Plt, INR düzeyleri, yan etkiler ve komplikasyonlar kaydedildi ve değerlendirildi. Bulgular: Füzyon uygulanan omurga segmentlerinin median değeri 12 (7-13) idi. İntraoperatif kan kaybı operasyon sırasında 1448.53 ± 767.18 ml, füzyon uygulanan spinal segment başına 133.85 ± 61.77 ml ve operasyon süresine göre saatte 172.79 ± 82.12 ml idi. Primer cerrahi geçiren hastalarda intraoperatif kan kaybı revizyon hastalarına göre anlamlı olarak düşük olmakla birlikte, postoperatif kan kaybı açısından fark yoktu. Spinal segment sayısı, ameliyat süresi, yaş ve ASA ile doğru orantılıydı. Transfüze edilen ortalama kırmızı kan hücresi miktarı 1.5 ± 1.29 U idi. Hastalarımızda tromboemboli, nöbet veya böbrek yetmezliği gibi önemli bir komplikasyon ve yan etki ile karşılaşılmamıştı. Sonuç: Uygun dozajlar henüz belirlenmemesine rağmen, vertebra ameliyatlarında TXA'in 50 mg / kg yükleme dozunun önemli yan etkilere neden olmadan güvenle kullanılabileceğini düşünmekteyiz.

Anahtar Kelimeler: Traneksamik asit; skolyoz; spinal füzyon; kan kaybı,cerrahi; antifibrinolitik ajanlar
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