Journal article
Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion—a trial stopped early
BJA open, Vol.14, 100403
06/2025
DOI: 10.1016/j.bjao.2025.100403
PMCID: PMC12019205
PMID: 40276619
Abstract
Postoperative delirium may be mediated by systemic inflammation and neuroinflammation. By inhibiting the proinflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA on blood loss, adding measures of delirium, cognition, systemic inflammation, and astrocyte activation.
Adults undergoing elective posterior lumbar fusion randomly received intraoperative i.v. TXA (n=43: 10 mg kg−1 loading dose, 2 mg kg−1 h−1 infusion) or placebo (n=40). Blood was collected before surgery and 24 h after surgery (n=32) for biomarkers (cytokines and S100B). Participants had twice daily delirium assessments (n=65). Participants underwent four measures of cognitive function before surgery and during post-discharge follow-up.
Postoperative blood loss was ∼38% less in the TXA group compared with the placebo group with medians of 128 and 207 ml level−1, respectively, P=0.013. Total blood loss in the TXA and placebo groups did not differ with medians of 305 and 333 ml level−1, respectively, P=0.472. Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the placebo group (11/33=33%); P=0.408, effect size =–0.258 (95% confidence interval –0.744 to 0.229).
A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion.
NCT04272606.
Details
- Title: Subtitle
- Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion—a trial stopped early
- Creators
- Bradley J. Hindman - Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USACatherine R. Olinger - University of IowaRoyce W. Woodroffe - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USAMario Zanaty - University of IowaCarolina Deifelt Streese - University of Iowa, NeurosurgeryZeb R. Zacharias - Human Immunology Core Laboratory, University of Iowa, Iowa City, IA, USAJon C.D. Houtman - University of IowaLinder H. Wendt - University of IowaPatrick P. Ten Eyck - University of IowaDebra J. O'Connell-Moore - University of IowaEmanuel J. Ray - University of IowaSarah J. Lee - University of IowaDaniel F. Waldschmidt - University of IowaLauren G. Havertape - University of IowaLanchi B. Nguyen - University of IowaPei-fu Chen - Far Eastern Memorial HospitalMatthew I. Banks - University of Wisconsin School of Medicine and Public HealthRobert D. Sanders - The University of SydneyMatthew A. Howard - University of Iowa
- Resource Type
- Journal article
- Publication Details
- BJA open, Vol.14, 100403
- DOI
- 10.1016/j.bjao.2025.100403
- PMID
- 40276619
- PMCID
- PMC12019205
- NLM abbreviation
- BJA Open
- ISSN
- 2772-6096
- eISSN
- 2772-6096
- Publisher
- Elsevier Ltd; AMSTERDAM
- Grant note
- National Center For Advancing Translational Sciences of the National Institutes of Health: UL1TR004403 National Cancer Institute at the National Institutes of Health: P30CA086862
National Center For Advancing Translational Sciences of the National Institutes of Health (UL1TR004403) ; National Cancer Institute at the National Institutes of Health (P30CA086862) ; The University of Iowa Roy J. and Lucille A. Carver College of Medicine Department of Neurosurgery. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Language
- English
- Date published
- 06/2025
- Academic Unit
- Neurology; Microbiology and Immunology; Iowa Neuroscience Institute; Biostatistics; Orthopedics and Rehabilitation; Family and Community Medicine; Anesthesia; Neurosurgery; Otolaryngology; Holden Comprehensive Cancer Center; Internal Medicine; Design Biostat and Ethics
- Record Identifier
- 9984810944502771
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