Systematic Review and Meta-Analysis of Perioperative Intravenous Tranexamic Acid Use in Spinal SurgeryReport as inadecuate

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Tranexamic 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.


We 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.


Totally, 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.


The 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.

Author: Baohui Yang, Haopeng Li , Dong Wang, Xijing He, Chun Zhang, Pinglin Yang



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