Oral Tranexamic Acid Costs Less Yet Equally Effective

Whether administered orally or intravenously, tranexamic acid is effective at reducing blood loss after small and large spinal fusions. Oral tranexamic acid, however, costs less and may be overall more cost-effective, researchers say.

In the study, “Oral Is as Effective as Intravenous Tranexamic Acid at Reducing Blood Loss in Thoracolumbar Spinal Fusions,” the researchers conducted a prospective randomized trial to compare perioperative blood loss in patients undergoing elective thoracolumbar fusion who were treated with either IV or oral tranexamic acid.

The findings are published in the January 2022 issue of Spine.

All the patients had the surgery at a university affiliated tertiary medical center between February 2017 and March 2020.

“The use of antifibrinolytic agents such as tranexamic acid to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. Although evidence supports the use of intravenous and topic formulations of tranexamic acid in spine surgery, the use of oral tranexamic acid has not been studied,” the researchers said.

Overall, there were 261 patients randomized to receive 1.95 g of oral tranexamic acid 2 hours preoperatively or 2 g IV tranexamic (1 g before incision and 1 g before wound closure) intraoperatively. Patients were then further stratified by levels of fusions.

The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay.

In total, 137 patients received IV and 124 received oral tranexamic acid. The average age of patients was 62 and there were 141 females and 120 males. Revision cases comprised 67% of the total patient population.

The mean reduction of hemoglobin was similar between IV and oral groups (3.56 vs. 3.28 g/dL, respectively; p = 0.002, equivalence). The IV group had a higher transfusion rate compared to the oral group (22 patients [19%] vs. 12 patients [10%]; p = 0.03). The IV group also had longer length of stay.

“Patients treated with IV and oral tranexamic acid experienced the same perioperative blood loss after small and large spinal fusions. In subgroup analysis, the intermediate (three to five level) spinal fusions had less blood loss with oral tranexamic acid than with IV tranexamic acid. Given its lower cost, oral tranexamic acid represents a superior alternative to IV tranexamic acid in patients undergoing elective posterior thoracolumbar fusion and may improve health care cost-efficiency in the studies population,” the researchers wrote.

The study authors included Mohsin Fidai, M.D., Travis Washington, M.D., Stephen Bartol, M.D. and Gregory Graziano, M.D., of Henry Ford Health System in Detroit, Michigan. Charles Yu, M.D., of Norton Leatherman Spine Center in Louisville, Kentucky, also was involved in the study.