Balancing Safety and Bleeding Risks: Safety of TXA Use in Endoscopic Spine Surgery

Introduction: Effective hemostasis is crucial in spine surgery to prevent postoperative hematomas and neurological complications. Tranexamic acid (TXA), an antifibrinolytic agent, reduces bleeding by inhibiting plasminogen activation. Although widely used in spine surgery, concerns about its thrombotic risks persist. This study evaluates the safety and efficacy of TXA in endoscopic spine surgery.

Methods: We conducted a retrospective review of 92 patients who underwent endoscopic spine surgery from 2023 to 2024. Patients were divided into two groups: 25 who did not receive TXA and 67 who did (59 received 1g, 7 received 2g). Postoperative complications, including deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), infection, and nerve injuries, were assessed using chi-square and Pearson’s correlation analysis. Statistical significance was set at p ≤ 0.05.

Results: TXA was associated with a statistically significant reduction in infection rates (p = 0.016). A weak but significant negative correlation (r = -0.257, p = 0.022) between TXA dosage and infection was observed. No significant differences were found in intraoperative (p = 0.301) or postoperative (p = 0.535) complications between groups. Thrombotic events (1 DVT, 1 cephalic vein thrombosis, 1 PE) occurred but showed no significant correlation with TXA use (p = 0.177). There were no cases of epidural or subdural hematomas.

Conclusion : TXA use in endoscopic spine surgery appears to reduce infection rates without increasing thrombotic risks. These findings support the safety of TXA in this setting, although larger studies are warranted to confirm its safety profile, especially in patients at risk for thrombosis.