Effects of hemostatic gauze and tranexamic acid on perioperative hemorrhage and safety of posterior cervical decompressive laminectomy

  Objective  To compare the effects of intravenous infusion of tranexamic acid and local application of hemostatic gauze on perioperative hemorrhage and safety during posterior cervical decompressive laminectomy.

  Methods  A total of 106 patients with cervical spondylotic myelopathy who underwent posterior cervical laminectomy and decompression were selected as study objects. The patients were randomly divided into tranexamic acid group (n=35), hemostatic group (n=35) and control group (n=36). The control group received conventional treatment, the hemostatic group was implanted hemostatic gauze in the operation area during the operation, and the tranexamic acid group received intravenous infusion of tranexamic acid after the operation. The total blood loss, apparent blood loss, invisible blood loss and postoperative total drainage volume were compared among the three groups. The hemoglobin, hematocrit, platelets, coagulation function indicators and inflammation related indicators of three groups before and 3 days after surgery were compared.

  Results  Total blood loss, apparent blood loss, invisible blood loss and postoperative total drainage in the hemostatic group and tranexamic acid group were significantly less than those in the control group (P < 0.05), and the above indicators of the hemostatic group were also significantly less than those of the tranexamic acid group (P < 0.05). There were no significant differences in the levels of hemoglobin and hematocrit in the three groups at the third postoperative days (P>0.05). The D-dimer and fibrinogen levels at 3 d of the three groups were significantly higher than that of before operation, and the above indicators of the tranexamic acid group were higher than the control group and the hemostatic group (P < 0.05). There were no statistically significant differences in the percentages of white blood cells, neutrophils, and C-reactive protein levels in the three groups at 3 days postoperation (P>0.05).

  Conclusion  The hemostatic effect and safety of hemostatic gauze in posterior cervical decompressive laminectomy are better than those of intravenous drip of tranexamic acid.