1.
The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis
Luo W, Sun RX, Jiang H, Ma XL
Journal of Orthopaedic Surgery. 13(1):96, 2018 Apr 24.. 2018;13((1):):96
Abstract
BACKGROUND We 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. METHODS Potentially 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. RESULTS Three 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. CONCLUSIONS The 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.
2.
Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials
Li ZJ, Fu X, Xing D, Zhang HF, Zang JC, Ma XL
European Spine Journal. 2013;22((9):):1950-7.
Abstract
PURPOSE The present meta-analysis aimed at assessing the effectiveness and safety of tranexamic acid (TXA) in reducing blood loss and transfusion in spinal surgery. METHODS Systematic searches of all studies published through March 2012 were identified from PubMed, EMBase, Cochrane library, Science Direct, and other databases. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers searched and assessed the literature. Mean difference (MD) of blood loss and blood transfusions, risk ratios (RR) of transfusion rate and of deep vein thrombosis rate in the TXA-treated group versus placebo group were pooled throughout the study. The meta-analysis was conducted by RevMan 5.1 software. RESULTS Six placebo-controlled RCTs encompassing 411 patients met the inclusion criteria for our meta-analysis. The use of TXA significantly reduced both total blood loss [MD=-285.35, 95% CI (-507.03 to -63.67), P=0.01] as well as the number of patients requiring blood transfusion [RR=0.71, 95% CI (0.54-0.92), P=0.01]. None of the patients in the treatment group had deep-vein thrombosis (DVT) or pulmonary embolism. CONCLUSIONS Intravenous use of TXA for patients undergoing spinal surgery is effective and safe. It reduces total blood loss and the need for blood transfusion, particularly in the using of high dosage of TXA (>=15mg/kg), yet does not increase the risk of postoperative DVT. Due to the limitation of the quality of the evidence currently available, high-quality RCTs are required.