Marijuana Use is Not a Contraindication for Tranexamic Acid Utilization in Lumbar Spine Surgery

Study Design Retrospective cohort study Objective The purpose of this study was to evaluate safety in lumbar spinal fusion with tranexamic acid (TXA) utilization in patients using marijuana. Methods This was a retrospective cohort study involving a single surgeon’s cases of 1 to 4 level lumbar fusion procedures. Two hundred and ninety-four patients were followed for ninety days post-operatively. Consecutive patients were self-reported for daily marijuana use (n = 146) and compared to a similar cohort of patients who denied usage of marijuana (n = 146). Outcomes were collected, which included length of stay (LOS), estimated blood loss (EBL), post-operative myocardial infarction, seizures, deep venous thrombosis, pulmonary embolus, death, readmission, need for further surgery, infection, anaphylaxis, acute renal injury, and need for blood product transfusion. Results Patients in the marijuana usage cohort had similar age (58.9 years ±12.9 vs 58.7 years ±14.8, P = .903) and distribution of levels fused ( P = .431) compared to the non-usage cohort. Thromboembolic events were rare in both groups (marijuana usage: 1 vs non-usage: 2). Compared to the non-usage cohort, the marijuana usage cohort had a similar average EBL (329.9 ± 298.5 mL vs 374.5 ± 363.8 mL; P = .254). Multivariate regression modeling demonstrated that neither EBL (OR 1.27, 95% CI 0.64-2.49) nor need for transfusion (OR 1.56, 95% CI 0.43-5.72) varied between cohorts. The non-usage cohort had twice the risk of prolonged LOS compared to the marijuana usage cohort (OR 2.05, 95% CI 1.15-3.63). Conclusion Marijuana use should not be considered a contraindication for TXA utilization in lumbar spine surgery.

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Peri-operative complications of lumbar spine surgery in patients over eighty five years of age: a retrospective cohort study

International Orthopaedics ◽

10.1007/s00264-018-3875-1 ◽

2018 ◽

Vol 42 (5) ◽

pp. 1083-1089 ◽

Cited By ~ 3

Author(s):

Shingo Onda ◽

Masahiro Kanayama ◽

Tomoyuki Hashimoto ◽

Fumihiro Oha ◽

Akira Iwata ◽

...

Keyword(s):

Cohort Study ◽

Lumbar Spine ◽

Spine Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lumbar Spine Surgery ◽

Operative Complications

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Remifentanil versus fentanyl in total intravenous anesthesia for lumbar spine surgery: a retrospective cohort study

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2015.03.024 ◽

2015 ◽

Vol 27 (5) ◽

pp. 391-395 ◽

Cited By ~ 2

Author(s):

Berlet Thomas

Keyword(s):

Cohort Study ◽

Lumbar Spine ◽

Spine Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Total Intravenous Anesthesia ◽

Lumbar Spine Surgery ◽

Intravenous Anesthesia

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A Retrospective Cohort Study of Effects of Antihypertensive and Anticholinergic Medications on Outcomes Following Elective Posterior Lumbar Spine Surgery

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001110 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Joshua L. Golubovsky ◽

Jaret M. Karnuta ◽

Maxwell Lee ◽

Jacob Enders ◽

Aditya Banerjee ◽

...

Keyword(s):

Cohort Study ◽

Lumbar Spine ◽

Spine Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lumbar Spine Surgery ◽

Anticholinergic Medications

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Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine1814 ◽

2019 ◽

Vol 31 (2) ◽

pp. 194-200 ◽

Cited By ~ 1

Author(s):

Signe Elmose ◽

Mikkel Ø. Andersen ◽

Else Bay Andresen ◽

Leah Yacat Carreon

Keyword(s):

Placebo Group ◽

Lumbar Spine ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Operative Time ◽

Decompressive Surgery ◽

Lumbar Spine Surgery ◽

Intraoperative Blood Loss ◽

Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

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