Objective To explore effect and safety of local combined application of tranexamic acid (TXA) on postoperative bleeding in patients with lumbar spinal stenosis (LSS).

Methods Sixty elderly patients with LSS who underwent two-level transforaminal lumbar interbody fusion (TLIF) for the first time were selected, and randomly divided into TXA group and control group, with 30 cases in each group.The TXA group was immersed in 200 mL TXA injection before the incision was closed, and 50 mL TXA injection was injected into the incision through drainage tubes on both sides immediately after the incision was closed; the control group was immersed 200 mL normal saline before the incision was closed, and 50 mL normal saline was injected into the incision through both sides of the drainage tube immediately after the incision was closed, and the drainage tubes were clamped for 1 hour immediately after perfusion in both groups.The preoperative general information, drainage flow at the first three 8 hours after surgery, total drainage flow after operation, extubation time, hemoglobin (Hb) at 3 and 7 days after surgery, postoperative blood transfusion and complications of the two groups were compared.

Results The drainage volume and total drainage volume in the first three 8 hours after operation in the TXA group were significantly less, and the extubation time was significantly shorter than that in the control group (P < 0.05).At three and seven days after surgery, Hb in the TXA group was significantly higher than that in the control group (P < 0.05).The postoperative transfusion rate of the TXA group was 6.7%, which was significantly lower than 23.3% of the control group (P < 0.05).The blood transfusion volume in the TXA group was (1.4±0.4) U, which was significantly less than (2.3±0.6) U in the control group (P < 0.05).There was no deep venous thrombosis of lower limbs in two groups after operation; incision healing was grade A in both groups; no wound infection and hematoma compression of nerve were found in two groups within three months after surgery.

Conclusion Local combined application of TXA has a good hemostasis effect in elderly patients with LSS, and the therapy has no adverse reactions and high safety.