A Meta-analysis Of The Hemostatic Effects Of Intravenous And Topical Tranexamic Acid In Spinal Surgery

Background:Tranexamic acid(TXA)is an antifibrinolytic agent that interferes with fibrinolysis and has been used to reduce blood loss in spinal surgery for many years.The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in spine surgery.Methods:We searched multiple databases including PubMed,Embase,the Cochrane library,and China National Knowledge Infrastructure databases(CNKI),WanFang Database,and Chinese Scientific Journal Database(VIP)to identify studies that met the inclusion criteria.A meta-analysis was performed according to the guidelines of the Cochrane Reviewer’s Handbook and the PRISMA statement.Results:Eight randomized controlled trials(RCTs)were identified,including 660 patients.No significant differences were found in the two groups regarding total blood loss(TBL),intraoperative blood loss(IBL),hidden blood loss(HBL),hematocrit(HCT),hemoglobin(Hb),fibrinogen(FIB),postoperative prothrombin time(PT),postoperative activated partial thromboplastin time(APTT),drainage volume,and blood transfusion rate.There were statistically significant differences in the two groups in terms of preoperative PT(MD=-0.39,95%CI:[-0.63,-0.15],P=0.002)and preoperative APTT(MD=1.12,95%CI:[0.57,1.68],P<0.0001).Conclusions:During spinal surgery,intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group.According to the pooled analysis of PT and APTT,intravenous and topical TXA may have different effects on the coagulation pathway.More high-quality RCTs are needed to explore the optimal dosage,method,timing in the future in order to recommend TXA widespread use in spine surgery.