Compare Between the Effect of Topical Tranexamic Acid Versus Hydrogen Peroxide on Blood Loss in Spine Surgeries

Study Overview
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Brief Summary
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To evaluate the effectiveness of topical TXA in reducing blood loss compared to H2O2 wash. The primary outcomes : Estimation of Intraoperative blood loss and blood transfusion. Recording Postoperative blood drainage. Comparing Hemoglobin levels (pre and postoperative). The secondary outcomes : Surgical site infection (SSI) Length of hospital stay.

Detailed Description
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Spinal surgery is one of the most commonly performed neuro-surgeries worldwide. Massive blood loss occurs frequently and remains a challenge in complex spinal surgery. Significant intra and postoperative hemorrhage negatively affects patient outcomes by increasing coagulopathy, postoperative hematoma and anemia .The need for allogenic blood transfusions can lead to potential transfusion reactions and infections, in addition to increasing long-term mortality rates. There is an economic disadvantage associated with iatrogenic major blood loss relating to the direct costs of the blood products and intraoperative blood salvage technology and indirect costs of prolonged patient hospitalization and complication management . Many efforts have focused on achieving better perioperative blood conservation, in particular through prophylactic intravenous administration of antifibrinolytic agents before and during major surgery. Intravenous administration of the inexpensive but highly effective drug as tranexamic acid (TXA) reduces perioperative hemorrhage and the need for blood transfusions by one third in major surgery, including spinal surgery, Included on the list of the World Health Organization (WHO) List of Essential Medicines, TXA has taken its place as a widely used hemostatic agent in the clinical setting . Tranexamic acid is a synthetic analog of the amino acid lysine. It serves as an antifibrinolytic by reversibly binding four to five lysine receptor sites on plasminogen. This reduces conversion of plasminogen to plasmin, preventing fibrin degradation and preserving the framework of fibrin's matrix structure .Tranexamic acid has roughly eight times the antifibrinolytic activity of an older analogue, ε-aminocaproic acid. Tranexamic acid also directly inhibits the activity of plasmin with weak potency . Hydrogen peroxide (H2O2) is an inexpensive and readily available option whose hemostatic and antiseptic properties have been separately confirmedin several previous studies .

Official Title
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Comparison Between the Effect of Topical Tranexamic Acid Versus Hydrogen Peroxide on Perioperative Blood Loss in Elective Spine Surgeries

Conditions
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Blood Loss

Intervention / Treatment
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* Drug: Topical Solution
* Drug: Topical Foam
* Other: Topical


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA: class II or III Sex: male and female Age: from 20 to 70 years. Type of operation: patient will undergo spinal surgery with a diagnosis of in place spinal trauma, thoracic or lumbar degenerative disease, such as spinal canal stenosis, disc herniation, spondylolisthesis, and/or degenerative scoliosis under general anesthesia. Exclusion Criteria: Patients with history of thromboembolic disease or coagulopathy or hereditary bleeding disorders such as factor VIII deficiency, factor IX deficiency, and Von-Willebrand disease. Patients who were taking anticoagulants or antiplatelet drugs. Allergy or hypersensitivity to TXA. A dural tear accompanied by cerebrospinal fluid leakage detected intraoperatively. Spinal cord tumors, head trauma and penetrating spinal cord trauma. The use of intravenous TXA during the perioperative period . Infection at the operative site e.g T.B.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: tranexamic acid<br>Topical hemostatics as tranexamic acid or hydrogen peroxide in wound before skin closure to decrease perioperative blood loss | Drug: Topical Solution<br>* Topical administration<br>* Other names: Irrigation;Drug: Topical Foam<br>* Topical administration<br>* Other names: Disinfectant;Other: Topical<br>* Topical administration<br>* Other names: Crystalloid;|
| Active Comparator: Hydrogen peroxide<br>Topical hemostatics as hydrogen peroxide in wound before skin closure to decrease perioperative blood loss | Drug: Topical Solution<br>* Topical administration<br>* Other names: Irrigation;Drug: Topical Foam<br>* Topical administration<br>* Other names: Disinfectant;Other: Topical<br>* Topical administration<br>* Other names: Crystalloid;|
| Placebo Comparator: Normal saline<br>Hemostasis in spine surgery | Drug: Topical Solution<br>* Topical administration<br>* Other names: Irrigation;Drug: Topical Foam<br>* Topical administration<br>* Other names: Disinfectant;Other: Topical<br>* Topical administration<br>* Other names: Crystalloid;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood loss estimation [NCT ID not yet assigned] | Estimation of perioperative blood loss and need of blood transfusion, lab investigations pre and postoperative (hemoglobin (gm/dL), hematocrit (%), Prothrombin concentration (%), INR, platelets). Recording Postoperative blood drainage (in ml). and Comparing Hemoglobin levels (pre and postoperative). | Within 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complications | Anaemia secondary to blood loss, surgical site infection , length of hospital stay (in days), complications of drugs used in procedure. | 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Blood loss