Prophylactic effects of tranexamic acid in spinal fusion: comparing blood loss and transfusion requirements in PLF vs. PLIF for isthmic spondylolisthesis

Background Isthmic Spondylolisthesis (IS) is characterized by the displacement of vertebral bones. Tranexamic acid (TXA), an antifibrinolytic agent, is used to mitigate intraoperative blood loss and the need for blood transfusions during spine surgery. This study aimed to compare the effectiveness of prophylactic TXA in reducing blood loss between the two distinct methods of treatment. Methods One hundred patients who underwent lumbar IS fusion were divided into two groups. Fifty patients underwent posterolateral fusion )PLF(, while the remaining 50 underwent surgery with posterior lumbar interbody fusion instruments (PLIF). Both groups received intravenous TXA as a 15 mg/kg bolus at anesthetic induction, followed by a continuous maintenance infusion of 1 mg/kg/h during surgery. Blood samples were collected at 24 and 48 h postoperatively to measure complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen levels, sodium, potassium, calcium, platelet count, blood transfusion requirements, and blood loss. Results At baseline, there was no significant difference between the two groups, except for a longer duration of surgery in the PLIF group ( P = 0.000). Following TXA treatment, there were no significant differences in recovery parameters, CBC parameters, PT, PTT, or fibrinogen levels in the arterial blood between the two groups. A significant difference was observed in urine volume during surgery, although no significant difference was observed in blood loss. Conclusion The study found that no significant intergroup differences were observed in CBC, PT, PTT, fibrinogen levels, and blood loss during surgery after the TXA administration.