Tranexamic Acid to Reduce Blood Loss in Spine Surgery

Recruiting now · Phase 2/Phase 3 · Has a placebo group

Conditions studied: Spinal Injuries, Spinal Deformity

In brief

This study is designed to evaluate the efficacy of topical tranexamic acid to reduce perioperative blood loss, reduction in postoperative drain output and allogenic transfusion requirements. The proposed study will be a prospective, randomized, double-blind (subject, surgeons, investigators, research coordinators) placebo-controlled study. Patients requiring posterior spinal fusion will be enrolled for this study. Furthermore, patients undergoing elective complex deformity surgery will also be enrolled. Both populations of patients will be randomized into two groups. Group I will receive standard of care operative fixation with topical tranexamic acid intervention (test); Group II will receive standard of care operative fixation with normal saline (placebo) intervention. This study will have a 2-year follow-up and will consist of three periods: screening/enrollment phase up to 21 days from the day of injury to the day of randomization and operative intervention, an inpatient data collection period for 4 days postoperative, and then a follow-up period for 2-years postoperative (visits occurring at 16 weeks, 1 year, and 2 year) time points.

Key facts

Study ID

NCT02314988

Run by

Columbia University

People needed

252

Starts

2020-06-15

Expected to finish

2027-07-01

Last updated by the study team

2026-05-06

Who can join

Age: 18 and older, up to 80. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Thoracic or lumbar spinal column injury with or without neurologic deficit requiring surgical fixation
• Surgical fixation to be performed within 21 days of injury
• Adult patients undergoing long segment (>5 fusion levels) posterior spinal fusions

You may not qualify if…

• Age <18 or >80 years old
• Severe soft tissue disruption around planned surgical site preventing adequate primary wound closure
• Physiologic instability or ongoing sepsis/infection
• Use of intravenous tranexamic acid during the pre-study period
• Ballistic spinal column injury
• Allergy to tranexamic acid
• Disturbances of color vision or color blindness
• Pre-operative hemoglobin value of <7 g/dL, or <10 g/dL if patient has comorbidities or symptoms which will require pre-operative allogeneic blood transfusion
• Refusal to consent for blood products
• Participation in another clinical trial
• Moderate or severe traumatic brain injuries that do not allow participation in individual patient outcomes surveys
• Subarachnoid hemorrhage, anecdotal experience indicates that cerebral edema and cerebral infarction may be caused by TXA
• Concomitant use of Factor IX Complex concentrates or Anti-inhibitor Coagulant concentrates, as the risk of thrombosis may be increased
• Preoperative use of anticoagulant therapy (heparin, low-molecular weight heparin, warfarin) within three days before surgery, or non-steroid inflammatory medication (aspirin, ibuprofen, naprosyn) use within seven days before surgery
• Fibrinolytic disorders requiring intraoperative antifibrinolytic treatment
• Disseminated intravascular coagulation (DIC)
• Coagulopathy (as identified by a preoperative platelet count of <150,000/mm3, an international normalized ratio of >1.4, or a prolonged partial thromboplastin time >1.4 times normal)
• History of arterial or venous thromboembolic disease (such as a cerebrovascular accident, deep-vein thrombosis, or pulmonary embolus), as these patients may be at increased risk for venous or arterial thrombosis
• Upper urinary tract or ureteral injury (ureteral obstruction due to clot formation in patients with upper urinary tract bleeding has been reported)
• Pregnancy or breastfeeding (Category B)
• Substantial renal dysfunction (as assessed by a serum creatinine > 1.5 or calculated creatinine clearance of < 50) or hepatic failure
• Major co-morbidities: alcohol or drug abuse, illnesses that affect bone or calcium metabolism, connective tissue disorders, coronary artery disease, severe ischemic heart disease [New York Heart Association Class III or IV], previous myocardial infarction, severe pulmonary disease [forced expiratory volume <50% of normal], diabetes mellitus (Type I or Type II), immunosuppression, peripheral vascular disease, severe penetrating or hemorrhagic traumatic brain injury, a history of skeletal malignancies, prior external beam or implant radiation therapy involving the skeleton.
• History of seizure or convulsive disorders, or currently concomitant use of other medications that are known to reduce seizure threshold
• History of dural tear or open subdural space

Where it is running

• University of California San Francisco Medical Center — San Francisco, California, United States (enrolling)
• Norton Leatherman Spine Center — Louisville, Kentucky, United States (enrolling)
• NYP/The Allen Hospital - CUIMC — New York, New York, United States (enrolling)
• Duke University Medical Center — Durham, North Carolina, United States (enrolling)

Full record on ClinicalTrials.gov

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