Tranexamic Acid for Hemostasis in the Surgical Treatment of Metastatic Tumors of the Spine
Bibliographic record
Abstract
In Brief Study Design. This is a retrospective study of sequential cohorts. Objective. To assess the efficacy of tranexamic acid in decreasing operative blood loss and the need for intraoperative transfusion in metastatic spine surgery. Summary of Background Data. Significant published data have established the efficacy of antifibrinolytic drugs in limiting surgical bleeding during heart surgery and total joint replacement. One study in scoliosis suggested benefit in spine surgery as well. Methods. During a 6-month trial period, 14 patients with spine cancer undergoing palliative intralesional tumor excision and concomitant instrumentation to stabilize the spine in the hands of a single surgeon were administered tranexamic acid intraoperatively in the attempt to minimize operative blood loss. They were then compared to the immediately preceding 14 patients. Results. Estimated operative blood loss was 1385 mL in the study group treated with tranexamic acid and 1815 mL in controls not receiving the drug, and was not found to be significantly decreased in this study. Conclusions. Control of operative bleeding in metastatic spine surgery can be problematical. Optimum protocol might include routine preoperative angiographic tumor embolization to decrease lesion vascularity in all cases, but angiography is not without risk. Noninvasive prophylaxis of tumor bleeding would have obvious desirable advantages but was, unfortunately, not achieved in this study. Tranexamic acid is an antifibrinolytic drug widely used to control bleeding in cardiovascular surgery. Similar agents have decreased surgical blood loss in spine surgery for adolescent scoliosis. However, to our knowledge, the use of antifibrinolytics has not yet been reported in spine surgery for metastasis in which blood loss can be notoriously high. Sequential cohorts of patients with metastatic spine were treated surgically with and without infusion of this drug intraoperatively. No significant decrease in operative blood loss or intraoperative transfusion requirement was shown in this application.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".