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

Mingsheng Tan,Ping Yi,Junyuan Liu,Hao Wang,Zhencheng Xiong

doi:10.1155/2020/7403034

Abstract

Objective Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. Methods We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer's Handbook. Results Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, 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=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], Conclusion During nondeformity spine 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 application of 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.

Highlights

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]
Using Medical Subject Headings (MeSH) terms and corresponding keywords, we searched for the following terms “tranexamic acid,” “TXA,” “intravenous,” “topical,” “blood loss,” and “spine surgery” with the Boolean operators “AND or OR.”
We summarized the evaluation tools to compare the effect of intravenous versus topical administration of TXA during nondeformity spine surgery after carefully reading and analyzing the included articles, including blood loss (TBL, intraoperative blood loss (IBL), and hidden blood loss (HBL)), blood transfusion rate, HCT, prothrombin time (PT), activated partial thromboplastin time (APTT), FIB, Hb, and drainage volume [6,7,8,9,10,11,12,13]

Summary

Introduction

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]. One is to supplement blood loss in a variety of ways, and the other is to stop bleeding with drugs or materials. Among these hemostatic drugs, tranexamic acid (TXA) interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery [3]. Ere have been many studies demonstrating that intravenous or topical administration of TXA could reduce blood loss and allogenic blood transfusions without a high risk of complications such as deep vein thrombosis (DVT), pulmonary embolism (PE), or wound infection [4, 5]. Some studies have reported a comparison of the efficacy and safety of intravenous versus topical administration of TXA during

Methods

Results

Conclusion