The effect of application of topical tranexamic acid versus hydrogen peroxide on postoperative hemostasis in elective spine surgeries: a randomized controlled trial

Background: Spine surgery is usually associated with excessive blood loss that may necessitate a blood transfusion. Objectives: to evaluate the topical application of tranexamic acid versus hydrogen peroxide for hemostasis in patients undergoing elective spine surgeries under general anesthesia. Patients and Methods: One hundred twenty patients aged 20 to 60 participated in this prospective, randomized, single-blinded study. They were randomly allocated into three equal groups. Patients either receive topical tranexamic acid 2gm (Group T), 3% hydrogen peroxide (Group H), or normal saline in the control group (Group C), all in 100 mL volume, applied via irrigation before wound closure for 3 minutes. The primary endpoint was the estimation of postoperative blood loss within the first 48 hours. Secondary outcomes included: hemoglobin and hematocrit values, frequency of blood transfusion, and length of hospital stay. Results: There were differences in postoperative blood loss at the first and second 24 hours in group T (194.1 ml and 98.1 ml) compared to group H (328.2 ml and 199.5 ml) and groups C (367.5 ml and 227.5 ml) with a p-value of 0.001. Postoperative hemoglobin and hematocrit levels after 48 hours were best in group T (11.2 gm/dl) compared to the H and C groups (10.97 and 10.52 gm/dl, respectively) with a p-value of 0.041. Incidences of postoperative blood loss > 500 ml, blood transfusion, and the length of hospital stay in days were the least in group T, with a p-value of 0.001. Conclusion: The present study proves that topical tranexamic acid is superior to hydrogen peroxide in reducing postoperative blood loss and preserving hemoglobin and hematocrit. It also shortened the period of hospital stay.