Objective To investigate the clinical effect of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF)，analyze the main factors of the bleeding of PLIF，and provide a basis for individualized medication.Methods A total of 140 patients who underwent PLIF in our hospital from August 2021 to April 2022 were prospectively analyzed.Six patients were excluded and the remaining 134 patients were divided into two groups by randomization software.Patients in experimental group were intravenously injected with TXA 1 g 15 min before skin resection.Patients in control group were intravenously infusion with the same amount of normal saline 15 min before skin resection.Finally，130 patients were included in the final analysis.There were 66 cases in the experimental group，including 28 males and 38 females.The patients aged between 41~77 years，with an average age of (60.45±9.18) years.There were 64 cases in the control group，including 29 males and 35 females.The patients aged between 41~77 years，with an average age of (59.69±9.08) years.The blood loss，blood transfusion rate，incidence of thrombotic events and inflammatory index levels were compared between the two groups.Multiple regression analysis and stratified analysis were used to explore the factors affecting PLIF blood loss.Results The blood loss and blood transfusion rate in the experimental group were lower than those in the control group (P＜0.05).The level of C-reactive protein in the experimental group was lower than the control group，and the level of albumin was higher than the control group 24h after surgery (P＜0.05).There were no complications such as deep vein thrombosis，pulmonary embolism，and myocardial infarction in both groups.Multiple regression analysis showed that the preoperative application of TXA，gender，operation time，screw number，smoke history，incision length，blood transfusion，preoperative FIB，and preoperative Alb were the main factors which affect the total blood loss.Conclusion Preoperative application of TXA can reduce perioperative blood loss of PLIF without increasing the risk of postoperative thrombosis.Gender，operation time，screw number，smoke，incision length，blood transfusion，and preoperative FIB and Alb are the main factors affecting total blood loss.For patients with multiple surgical segments，long expected operation time，rich muscle in the lower back，low preoperative FIB，and smoke history.It is recommended to routinely use TXA before surgery.
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