Blood Loss During Spine Surgery

Abstract

Major bleeding is a serious adverse event of spine surgery. General preventive strategies to minimize blood loss include timely cessation of antithrombotic and antiplatelet agents, meticulous hemostasis and intraoperative blood salvage, and avoidance of hypertension. Prophylactic infusion of tranexamic acid or recombinant activated factor VII decreases blood loss and the need for allogenic blood transfusion during surgery. In time-sensitive surgery and during unanticipated intraoperative blood loss, it may be necessary to reverse preoperative antithrombotic and antiplatelet therapy with protamine, prothrombin complex concentrates, vitamin K, fresh frozen plasma, and platelet transfusion. During massive transfusion, prompt management of hypothermia, acidosis, and coagulopathy may improve outcome.