Zahra W, Nayar SK, Bhadresha A, Jasani V, Aftab S. Safety of tranexamic acid in surgically treated isolated spine trauma. World J Orthop 2024; 15(4): 346-354 [PMID: 38680673 DOI: 10.5312/wjo.v15.i4.346]
Corresponding Author of This Article
Wajiha Zahra, MBBS, MSc, MRCS, Specialty Registrar Trauma & Orthopedics, University Hospital of North Midlands NHS Trust, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom. wajiha.zahra@nhs.net
Research Domain of This Article
Orthopedics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wajiha Zahra, Trauma and Orthopedics Department, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Sandeep Krishan Nayar, Ashwin Bhadresha, Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
Vinay Jasani, Craniospinal Services, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Syed Aftab, Spine Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
Author contributions: Zahra W, Nayar SK, and Bhadresha A contributed to data collection; Zahra W and Nayar SK contributed to data analysis; Jasani V and Aftab S contributed to supervision; Zahra W, Jasani V and Aftab S contributed to project idea; Zahra W contributed to writing the manuscript and literature review; Nayar SK contributed to review the manuscript; Jasani V and Aftab S contributed to overall supervision.
Institutional review board statement: The project is reviewed and registered with the audit registration team of Royal Stoke University Hospital (No: CA44/21).
Informed consent statement: Informed written consent was obtained from the patients.
Conflict-of-interest statement: We certify that there is no conflict of interest related to the manuscript.
Data sharing statement: Consent was not obtained but the presented data are anonymized.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wajiha Zahra, MBBS, MSc, MRCS, Specialty Registrar Trauma & Orthopedics, University Hospital of North Midlands NHS Trust, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom. wajiha.zahra@nhs.net
Received: November 10, 2023 Peer-review started: November 10, 2023 First decision: January 12, 2024 Revised: February 7, 2024 Accepted: March 19, 2024 Article in press: March 19, 2024 Published online: April 18, 2024 Processing time: 157 Days and 8.9 Hours
ARTICLE HIGHLIGHTS
Research background
There is no data looking at safety of the tranexamic acid (TXA) in the surgical management of isolated whole spine trauma. This study sets the foundation for the future research work.
Research motivation
This is the only study looking at the safety of TXA in surgically treated isolated whole spine trauma. There is no consensus on the administration, dosage and route of TXA delivered for these injuries.
Research objectives
The overall objective of this study is to look at the safety of the TXA in surgically treated isolated whole spine trauma.
Research methods
This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom. We used SPSS for statistical analysis.
Research results
We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% vs 56%). All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min, compared with 24 patients (58%) in the non-TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 min. Among patients who received TXA, blood loss was < 150 and 150–300 mL in 8 (31%) and 15 (58%) patients, respectively. There were no cases of thromboembolic events in any patient who received TXA.
Research conclusions
We concluded that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases.
Research perspectives
This study sets the foundation for further research trials in patients with isolated spine trauma managed with surgical intervention.
