Systematic Review and Meta-Analysis of Perioperative Intravenous Tranexamic Acid Use in Spinal Surgery

Abstract

BackgroundTranexamic acid (TXA) is well-established as a versatile oral, intramuscular, and intravenous (IV) antifibrinolytic agent. However, the efficacy of IV TXA in reducing perioperative blood transfusion in spinal surgery is poorly documented.MethodologyWe conducted a meta-analysis of randomized controlled trials (RCTs) and quasi-randomized (qi-RCTs) trials that included patients for various spinal surgeries, such as adolescent scoliosis surgery administered with perioperative IV TXA according to Cochrane Collaboration guidelines using electronic PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. Additional journal articles and conference proceedings were manually located by two independent researchers.ResultsTotally, nine studies were included, with a total sample size of 581 patients. Mean blood loss was decreased in patients treated with perioperative IV TXA by 128.28 ml intraoperatively (ranging from 33.84 to 222.73 ml), 98.49 ml postoperatively (ranging from 83.22 to 113.77 ml), and 389.21 ml combined (ranging from 177.83 to 600.60 ml). The mean volume of transfused packed cells were reduced by 134.55 ml (ranging 51.64 to 217.46) (95% CI; P = 0.0001). Overall, the number of patients treated with TXA who required blood transfusions was lower by 35% than that of patients treated with the comparator and who required blood transfusions (RR 0.65; 95% CI; 0.53 to 0.85; P<0.0001, I2 = 0%). A dose-independent beneficial effect of TXA was observed, and confirmed in subgroup and sensitivity analyses. A total of seven studies reported DVT data. The study containing only a single DVT case was not combined.ConclusionsThe blood loss was reduced in spinal surgery patients with perioperative IV TXA treatment. Also the percentage of spinal surgery patients who required blood transfusion was significantly decreased. Further evaluation is required to confirm our findings before TXA can be safely used in patients undergoing spine surgery.

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

“…part to the less robust available body of TXA-spine literature. A metaanalysis by Li, et al examining six placebo controlled trials found no significant increase in risk of DVT, however other recent meta analyses have been less absolute in their conclusions about thromboembolic risk, citing a relatively small number of patients and investigations included within their scope of analysis that may be insufficient to make definitive claims on DVT and PE risk [37,45,46]. Future investigations with larger patient cohorts in the coming years will shed further light on the safety of TXA as a means to reduce blood loss in spinal surgery.…”

“…TXA has been widely used within complex spine surgery, from large scoliosis cases to smaller cervical spine procedures, but the majority of the literature on TXA use in adult patients focuses on scoliosis cases. As in total joint arthroplasty, the body of literature examining TXA in spine surgery consistently supports the use of TXA as a means of reducing blood loss and lowering transfusion rates, however the overall effects have been noted to be dose and timing dependent [37].…”

“…Topical TXA dosing has not been as extensively researched in spine surgery as in total joint surgery, but common dosing involves 250-500 mg used to irrigate the wound before closure [39,40]. The preponderance of evidence has demonstrated TXA to be both safe and effective at reducing blood loss and decreasing transfusion rates associated with spinal surgery [37,38,41,42] (Table 1).…”

A randomized prospective study of efficacy of Tranexamic Acid on Perioperative Blood Loss in Thoracic Spine Fixation

“…Recently a systematic review and meta-analysis of perioperative intravenous TXA use in spinal surgery by Yang et al 16 showed that when patients were treated with TXA, perioperative blood loss was reduced. Furthermore, the number of patients who required allogeneic blood transfusions was lower by 35%.…”

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

“…A variety of approaches have been employed to reduce perioperative blood loss [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67]. The development of protocols involves multidisciplinary collaboration between surgeons, anesthesiologists, hematologists, transfusion medicine and pharmacy.…”