Tranexamic acid dosage for spinal surgery: a meta-analysis

Qin, Chao; Du, Kaili; Guo, Peiyu; Gong, Hongda; Zhang, Chunqiang

doi:10.1007/s00586-022-07315-7

Cited by 6 publications

(12 citation statements)

References 25 publications

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“…Moreover, fewer complications were observed in patients who received a single dose of ≤15 mg/kg [31]. This finding is corroborated by research from Qin et al in 2022, which compared 740 patients receiving high and low doses of intravenous TXA and found no significant differences in terms of total blood loss, perioperative hemoglobin and hematocrit levels, operative time, and blood transfusion rates [32]. These results support our observations that different doses can cause a positive impact on the patients and that the dosage does not change the outcome in reducing mortality and blood loss, also we identify no adverse events in the administration of TXA in our studies that encompass the conclusions of previous studies.…”

Section: Discussionmentioning

confidence: 55%

Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review

Meza Monge,

Domene,

Diaz Mendoza

et al. 2024

Cureus

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Tranexamic acid (TXA), a fibrinolytic agent, effectively inhibits plasminogen activation, thereby reducing fibrinolysis and hemorrhage. This study focused on its application in trauma patients undergoing emergency surgery, a critical area due to trauma's significant role in mortality. Our investigation involved a meticulous screening of randomized controlled trials from databases including Scopus, PubMed, Web of Science, and Cochrane. The findings indicate that TXA intervention is promising in enhancing outcomes for trauma patients. However, the drug's effectiveness may vary based on the specific nature of the medical condition. In summary, robust evidence suggests that TXA can diminish blood loss, lower transfusion rates, reduce complications, and improve hemoglobin and hematocrit levels in surgical patients. Consequently, TXA should be considered a crucial medication, readily available to mitigate morbidity and mortality in surgical settings. Future research should explore factors influencing TXA's effectiveness in traumatic brain injury cases and across a broad spectrum of surgical scenarios in diverse patient populations. This would further guide clinicians in refining and optimizing the use of TXA.

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Section: Discussionmentioning

confidence: 55%

Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review

Meza Monge,

Domene,

Diaz Mendoza

et al. 2024

Cureus

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“…The effects of TXA in reducing blood loss were consistent with findings from the previous literatures. [64,65] Qin et al [66] conducted a systematic review about TXA for blood loss in spinal surgery. A total of 10 RCTs were finally included for systematic review and final results suggested that high dose of TXA was superior than low dose of TXA and placebo for blood loss in spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

et al. 2023

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Background: Significant blood loss is still one of the most frequent issues in spinal surgery. There were different hemostatic methods to prevent blood loss during spinal surgery. However, the optimal hemostatic therapy for spinal surgery is controversial. The purpose of this study was to assess the efficacy and safety of different hemostatic therapies in spinal surgery. Methods: Two independent reviewers conducted electronic literature searches in 3 electronic databases (PubMed, Embase, and Cochrane library database) as well as a manual search to identify eligible clinical studies from inception to Nov 2022. Studies that including different hemostatic therapy (tranexamic acid [TXA], epsilon-acetyl aminocaproic acid [EACA], and aprotinin [AP]) for spinal surgery were included. The Bayesian network meta-analysis was performed with a random effects model. The surface under the cumulative ranking curve (SUCRA) analysis was performed to determine the ranking order. All analyses were performed by R software and Stata software. P value less than .05 was identified as statistically significant. Results: Finally, a total of 34 randomized controlled trials met the inclusion criteria and finally included in this network meta-analysis. The SUCRA shows that TXA ranked first (SUCRA, 88.4%), AP ranked second (SUCRA, 71.6%), EACA ranked third (SUCRA, 39.9%), and placebo ranked the last (SUCRA, 0.3%) as for total blood loss. The SUCRA shows that TXA ranked first (SUCRA, 97.7%), AP ranked second (SUCRA, 55.8%), EACA ranked third (SUCRA, 46.2%), and placebo ranked the last (SUCRA, 0.2%) for need for transfusion. Conclusions: TXA appears optimal in the reduction of perioperative bleeding and blood transfusion during spinal surgery. However, considering the limitations in this study, more large-scale, well-designed randomized controlled trials are needed to confirm these findings.

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“…TXA is widely used in lumbar fusion surgery because it reduces IBL, OT, LOS, and even blood transfusion rates. [9–34] A systematic review and meta-analysis by Gong et al demonstrated that intravenous TXA during PLIF surgery is safe and can help reduce surgical blood loss; however, the authors concluded that it does not reduce transfusion rates. [10] Bai et al made similar conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinicians have adopted the use of antifibrinolytics, particularly tranexamic acid (TXA), in posterior lumbar fusion surgeries, and the TXA use has been demonstrated to help improve the perioperative clinical outcomes, such as reduction in intraoperative blood loss (IBL) and operative time (OT), transfusion rates, hidden blood loss, and length of hospital stay (LOS). [9–34] However, to date, studies comparing the differences in perioperative clinical outcomes with and without postoperative TXA administration are lacking. The impact of the postoperative TXA use on reducing postoperative drainage volume (PDV), LOS, and the rate of postoperative blood or albumin transfusions remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study

Ji,

Wang,

Shi

et al. 2023

Medicine

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The use of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) surgery is believed to be beneficial for reducing intraoperative blood loss, postoperative drainage volume (PDV), and length of hospital stay (LOS). However, whether continued administration of intravenous TXA within 24 hours after surgery is more beneficial to patients has not yet been studied. This study prospectively analyzed the perioperative outcomes of patients who received and did not receive intravenous TXA within 24 hours after PLIF (≥2 segments) surgery from January 2018 to December 2021. A total of 78 and 69 patients were included in the TXA (receive intravenous TXA intraoperatively and within 24 hours postoperatively) and non-TXA (only receive intravenous TXA intraoperatively) groups, respectively. No significant differences were observed in the intraoperative blood loss and operative time between the 2 groups. The postoperative drainage volume, postoperative drainage time, and length of hospital stay in the TXA group were significantly lower than those in the non-TXA group. The rates and volumes of postoperative blood and albumin transfusions were significantly lower in the TXA group than those in the non-TXA group. No significant differences were observed in the perioperative complication rates between the 2 groups. No increase in thrombosis-related complications was observed with postoperative TXA administration. Short-term TXA use after PLIF (≥2 segments) surgery is safe. In addition to intraoperative use of TXA, additionally administration of intravenous TXA within 24 hours postoperatively can improve the perioperative clinical outcomes of patients without increasing the risk of thrombotic events.

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Tranexamic acid dosage for spinal surgery: a meta-analysis

Cited by 6 publications

References 25 publications

Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review

Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study

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