While investigating the hemostatic efficacy of different tranexamic acid (TXA) management approaches on the blood loss in lumbar spinal fusion surgery, the combined use of TXA as intravenous and topicals achieved a much higher efficacy in decreasing TBL and transfusion rates. During the initial, 24 hours post-surgery, this combination could naturalize the fibrinolysis system and so, efficiently reduce blood loss in elderly patients.

This study aimed to evaluate the effectiveness of tranexamic acid (TXA) in intravenous (IV) along with topical administration in patients aged above years reserved for 2-level lumbar fusion surgery.

A total of 280 patients signed up for 2-level lumbar fusion surgery were divided into 4 groups, namely: an IV group (15 mg/kg IV-TXA), a local group (2 g TXA in local), a combined group (15 mg/kg of IV-TXA + 2 g TXA in local), and a control group (100 ml IV).

A comparison of outcomes of total blood loss (TBL), highest haemoglobin drop, rate of transfusion, and allogeneic blood units were done. The events connected with deep venous thrombosis (DVT) and pulmonary embolism (PE) were observed and documented.

The TBL for the four groups are as follows (Table 1).

Values expressed as the mean standard deviation. p values- significant difference among groups 

On average, the highest haemoglobin drop in the 4 above groups was 2.18 ± 0.24, 2.80 ± 0.37, 2.40 ± 0.64, and 3.40 ± 1.32 g/dL, correspondingly. During the follow-up, no PE was described. One, two, and two patients in combined, topical, and control group described asymptomatic DVT events; no intergroup difference was found.

Combination of TXA as IV and topical was effective in decreasing TBL in elderly patients aged over 60 reserved for lumbar fusion, without encouraging the occurrence of DVT and PE formation.