Combined Use of Tranexamic Acid and Rivaroxaban in Posterior/Transforaminal Lumbar Interbody Fusion Surgeries Safely Reduces Blood Loss and Incidence of Thrombosis: Evidence From a Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Abstract

Study Design:

A prospective, randomized, double-blind, placebo-controlled study.

Objectives:

There are few studies examining the balance between preventing venous thrombus embolism (VTE) and reducing blood loss in posterior/transforaminal lumbar interbody fusion (PLIF/TLIF) surgeries. This study aimed to evaluate the efficacy and safety of the combine application of TXA and rivaroxaban in patients undergoing PLIF/TLIF and explore relevant factors related to blood loss and VTE.

Methods:

Patients in group A which was the control group received 0.9% NaCl solution intravenously. Group B was treated by an intravenous injection of 2 g tranexamic acid (TXA) and the local use of 1 g intraoperatively. Group C was treated the same as group B intraoperatively, and they received 10 mg rivaroxaban qd treatment postoperatively. Eligible patients with an Autar score ≤ 10 were randomly assigned to group A or group B. Patients with an Autar score >10 were allocated into group C.

Results:

The intraoperative blood loss and postoperative drainage were lower in groups B and C than in group A ( P < .001). The blood transfusion rate in group B was lower than that in group A ( P < .001), while the incidence of VTE in group C was lower ( P < .001). Four factors were found to be positively correlated with obvious total blood loss ( P < .05). The data showed that 5 factors were correlated with the development of a thrombus ( P < .1).

Conclusions:

The combination of TXA and rivaroxaban in PLIF/TLIF patients is safe and effective in reducing D-dimer levels associated with VTE and reducing blood loss.