Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery

Abstract

Background: This study aimed to explore the role of tranexamic acid (TXA) in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery. Methods: In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library, and Web of Science from inception to June 23rd, 2020. Weighed mean difference (WMD) was used as the effect size for measurement data, and risk ratio for enumeration data. Publication bias was assessed by Begg test. Results: Totally 23 studies (11 randomized controlled trials and 12 cohort studies) involving 1621 participants were enrolled in this meta-analysis. The results showed that the administration of TXA can significantly decrease the intraoperative [WMD: –215.655, 95%CI: (–307.462, –123.847), P < .001], postoperative [WMD: –69.213, 95%CI: (–104.443, –33.983), P = .001] and total [WMD: –284.388, 95%CI: (–437.66, –131.116), P < .001] volumes of blood loss of patients undergoing multilevel spine surgery. It can also significantly reduce the intraoperative [WMD: –333.775, 95%CI: (–540.45, –127.099), P = .002] and postoperative [WMD: –114.661, 95%CI: (–219.58, –9.742), P = .032] volumes of transfusion. In addition, TXA was found to significantly increase the preoperative [WMD: 0.213, 95%CI: (0.037, 0.389), P = .018] and postoperative [WMD: 0.433, 95%CI: (0.244, 0.622), P < .001] hemoglobin levels as well as the preoperative platelet count [WMD: 14.069, 95%CI: (0.122, 28.015), P = .048]. Conclusion: The administration of TXA can effectively reduce blood loss and transfusion, and improve hemoglobin levels and preoperative platelet count in patients undergoing multilevel spine surgery.

Safety of intravenous tranexamic acid in patients undergoing supratentorial meningiomas resection: protocol for a randomised, parallel-group, placebo control, non-inferiority trial

“…neurosurgery, though it is a safe and effective means to reduce operative blood loss and blood transfusion rates in cardiac, pulmonary, trauma, obstetric, spinal and orthopaedic surgery. [11][12][13][14] As a synthetic lysine analogue, TXA can modify brain network excitability by activating excitatory ionotropic glutamate receptors. 15 16 On the other hand, TXA may induce hyperexcitability by blocking gamma-aminobutyric acid-driven inhibition of the central nervous system.…”

“…TXA is used as a bolus ranging from 10 to 50 mg/kg, followed by a continuous infusion ranging from 1 to 5 mg/kg/hour until the end of the procedures in a variety of neurosurgical procedures 3 8–10. Unfortunately, the risk of postoperative seizures remains uncertain, and restricts the routine use of TXA in neurosurgery, though it is a safe and effective means to reduce operative blood loss and blood transfusion rates in cardiac, pulmonary, trauma, obstetric, spinal and orthopaedic surgery 11–14…”

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations

“…Even in more complex, multi-level spine procedures that are especially associated with significant blood loss and can often require blood transfusions, TXA can significantly reduce blood loss and the risk of transfusions in patients undergoing these procedures. 52 , 53 More recent meta-analyses have aggregated RCTs, most prominently those giving IV TXA, in patients undergoing some form of spine surgery, and have further demonstrated that TXA can reduce the risk of blood transfusions in a dose-dependent manner without significantly increasing thrombosis in any circumstance. 48 , 51 However, these results were not observed in a similar meta-analysis including only studies where TXA was given topically, potentially indicating that the route of TXA administration can play a role in the drug’s effectiveness in reducing the risk of transfusions, which contrasts with similar studies in joint surgery.…”

Safety Of Tranexamic Acid Use In Pediatric Patients Undergoing Spinal Fusion Surgery: A Retrospective Comparative Cohort Study

“…[3][4][5] This medication has been extensively used in cardiac surgery [6][7][8] and other types of orthopedic surgery, [9][10][11][12][13] including spine surgery. 14,15 Two studies, with large sample sizes of 1,769 and 4,269 pediatric patients undergoing spinal surgery assessed TXA use, but their ndings were limited to TXA e ciency in decreasing blood loss without an analysis of adverse events associated with the drug. 16,17 A few smaller studies, with sample sizes ranging from 44 to 166 patients, reported on the safety of TXA use in this population and did not nd any associated adverse events.…”