The influence of tranexamic acid on intraoperative blood transfusion in short-segment PLIF and analysis of influencing factors of the transfusion: a retrospective case study

Background Tranexamic acid (TXA), with the chemical name of trans-4-aminomethylcyclohexanecarboxylic acid, is a synthetic hemostatic drug with antifibrinolytic activity. However, there remains uncertainty regarding the effect of TXA in reducing intraoperative blood transfusion (IBT) during short-segment posterior lumbar interbody fusion (PLIF). Therefore, this study investigates the chemical and clinical factors related to IBT. Methods A retrospective analysis was performed on the medical records of 402 patients who underwent short-segment PLIF between October 2020 and September 2024. Demographic indicators included age, gender, body mass index, history of hypertension, history of diabetes, and history of anticoagulation therapy. Laboratory test indicators included preoperative coagulation-related indicators and anemia-related indicators. Surgical-related indicators included disease type, surgical segment, operation time, intraoperative blood loss (IBL), and IBT. The drug-intervention factor was TXA. Patients who received intravenous TXA 15 min before surgery were classified as the observation group (97 cases), while those who did not were classified as the control group (305 cases). Univariate binary logistic regression analysis was used to explore the related influencing factors of IBT, and multivariate binary logistic regression analysis was further conducted to identify the independent influencing factors. A nomogram model was constructed to predict the probability of IBT. Results Both IBL and IBT in the observation group were lower than those in the control group, and the differences were statistically significant (p < 0.05). Univariate regression analysis revealed that IBT was significantly correlated with TXA, disease type, surgical segment, red blood cell count, hemoglobin, platelet count, operation time, and IBL (p < 0.05). Multivariate regression analysis demonstrated a strong association between IBL and IBT (p < 0.001). Further analysis excluding IBL indicated that the independent influencing factors of IBT included TXA, disease type, surgical segment and operation time (p < 0.05). The nomogram model showed that TXA was a protective factor, while disease type, surgical segment and operation time were risk factors. Conclusion In short-segment PLIF, TXA serves to reduce IBT by minimizing IBL. Moreover, it is an independent protective influencing factor for IBT. Conversely, the disease type, surgical segment, and operation time are independent risk influencing factors.