Systemic and Topical Use of Tranexamic Acid in Spinal Surgery: A Systematic Review

Abstract

Study Design Combination of narrative and systematic literature reviews. Objectives Massive perioperative blood loss in complex spinal surgery often requires blood transfusions and can negatively affect patient outcome. Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding. We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site. Through a systematic review of published and ongoing investigations on topical TXA for spinal surgery, we wish to make spine practitioners aware of this option and to suggest opportunities for further investigation in the field. Methods A narrative review of systemic TXA in spinal surgery and topical TXA in surgery was conducted. Furthermore, a systematic search (using PRISMA guidelines) of PubMed (MEDLINE), EMBASE, and Cochrane CENTRAL databases as well as World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov (National Institutes of Health), and International Standard Randomized Controlled Trial Number registries was conducted to identify both published literature and ongoing clinical trials on topical TXA in spinal surgery. Results Of 1,631 preliminary search results, 2 published studies were included in the systematic review. Out of 285 ongoing clinical trials matching the search criteria, a total of 4 relevant studies were included and reviewed. Conclusion Intravenous TXA is established as an efficacious hemostatic agent in spinal surgery. Use of topical TXA in surgery suggests similar hemostatic efficacy and potentially improved safety as compared with intravenous TXA. For spinal surgery, the literature on topical TXA is sparse but promising, warranting further clinical investigation and consideration as a clinical option in cases with significant anticipated surgical site blood loss.

Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis

“…Several studies have confirmed that TA does not increase the risk of deep vein thrombosis and pulmonary embolism. [8,9,11–16,19] In our study, no clinical symptoms of deep vein thrombosis or signs of pulmonary embolism were revealed. Any complications associated with TA, such as allergic reaction, stroke, ischemic heart disease, and dysfunction of liver and kidney, also did not occur.…”

“…These results showed the similar effect to those in previous studies. [9,11–14,16] The third difference with Wang et al was the administered dose regimen. More than 15 mg/kg is considered as a high dose regimen.…”

“…[9,11–17] Most of the previous studies focused on patients undergoing spinal correction surgery, [8,9,11,12,16,17] and only a few studies were involved in the patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis. [15,18] Since the surgical procedure for stenosis or spondylolisthesis is not identical to spinal correction surgery, it can be correlated with extensive exposure, long-segment fixation, spinal canal decompression, interbody fusion, [3–5] and massive blood loss.…”

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

“…THA/TKA is one of the operations with large blood loss in orthopedic surgery [31]. TXA, a hemostatic, is often used to prevent perioperative bleeding in TKA/THA [32]. However, the antifibrinolytic effect of TXA may increase the risk of DVT [33].…”

A hydrogel sealant for the treatment of severe hepatic and aortic trauma with a dissolution feature for post-emergent care

“…24–26 An alternative to these topical agents is the use of systemically administered hemostatic agents, however, selective clotting at only the intended site is a critical and required design feature. 27, 28 …”