The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis

Abstract

BackgroundWe conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy and safety of tranexamic acid (TXA) in spine surgery.MethodsPotentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966–2017.11), PubMed (1966–2017.11), Embase (1980–2017.11), and ScienceDirect (1985–2017.11). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and one non-RCT met the inclusion criteria. There were significant differences in total blood loss (MD = − 267.53, 95% CI − 373.04 to − 106.02, P < 0.00001), drainage volume (MD = − 157.00, 95% CI − 191.17 to − 122.84, P < 0.00001), postoperative hemoglobin level (MD = 0.95, 95% CI 0.44 to 1.47, P = 0.0003), and length of hospital stay (MD = − 1.42, 95% CI − 1.92 to − 0.93, P < 0.00001). No significant differences were found regarding transfusion requirement, deep vein thrombosis (DVT), pulmonary embolism (PE), wound hematoma, and infection between the two groups.ConclusionsThe present meta-analysis indicated that the topical application of TXA in spinal surgery decreases the total blood loss and drainage volume and preserves higher postoperative hemoglobin level without increasing the risk of DVT infection, hematoma, DVT, and PE.

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

“…TXA, an antifibrinolytic drug, was primarily used to treat or prevent excessive blood loss in orthopedic, cardiac, and spine surgery [1]. TXA can be administered in a variety of ways, including intravenous, topically, orally, or a combination thereof [1].…”

“…TXA, an antifibrinolytic drug, was primarily used to treat or prevent excessive blood loss in orthopedic, cardiac, and spine surgery [1]. TXA can be administered in a variety of ways, including intravenous, topically, orally, or a combination thereof [1]. TXA is usually given intravenously as a bolus prior to the incision and then maintained as a continuous infusion throughout the procedure [4].…”

“…Heterogeneity: tau 2 = 1.49, chi 2 = 12.46, df = 3 (P = 0.006); I 2 = 76% Test for overall effect: Z = 1.68 (P = 0.09) Test for subgroup differences: chi 2 = 1.08, df = 1 (P = 0.30); I 2 = 7.8% - careful analysis of the included studies, we found that the following reasons may be the source of heterogeneity: (1) e patients included in each article have different diseases, undergoing different spine surgeries, different doses of TXA;…”

“…Spine surgery is usually accompanied by significant blood loss during the perioperative period, which may lead to acute anemia and even serious complications [1]. ese conditions inevitably require significant blood transfusions and carry additional risks, such as infectious disease transmission, hemolysis, postoperative spinal epidural hematoma formation, anaphylactic reactions, and economic burden [2].…”

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

“…Evangelista et al [31] reported an elevated risk of deep vein thrombosis and pulmonary embolism after application of TXA. However, several meta-analyses showed TXA might not increase thromboembolic events in patients undergoing THA and the incidence of thromboembolic events was very low [30,[32][33][34][35]. Lucas-Polomeni et al [36] reported drug allergy with anaphylactic shock after intravenous TXA.…”