Meta-analysis of the efficacy and safety of tranexamic acid in open spinal surgery / 中国组织工程研究

ABSTRACT

OBJECTIVE: The perioperative optimization measures of accelerated rehabilitation surgery run through the whole hospitalization period of patients with open spinal surgery. The clinical efficacy and safety of tranexamic acid in open spinal surgery were evaluated using meta-analysis. METHODS: Databases of PubMed, Embase, Ovid, Cochrane Library, CNKI, CBM, Wanfang, and VIP were searched. According to the inclusion and exclusion criteria, ten prospective randomized controlled trials were obtained. Endnote software was utilized to manage the literature. The extracted data were analyzed using Revman 5.3 software for meta-analysis, mainly analyzing the intraoperative blood loss, postoperative blood loss, total perioperative blood loss, postoperative hemoglobin, operation time, length of hospital stay, blood transfusion rate, and thrombotic complications by using tranexamic acid in open spinal surgery. RESULTS: (1) A total of 10 high-quality prospective randomized controlled studies were included in 802 patients. (2) Meta-analysis results showed that tranexamic acid significantly reduced intraoperative blood loss (MD=-210.38, 95%CI-267.31 to-153.45, P < 0.000 01), postoperative drainage (MD=-113.40, 95%CI-126.97 to-99.83, P < 0.000 01), total perioperative blood loss (MD=-266.85, 95%CI-351.18 to-182.52, P < 0.000 01), and postoperative hemoglobin loss (SMD=0.20, 95%CI 0.02-0.38, P=0.03) compared with the control group, with significant difference. Moreover, the length of hospital stay (MD=-1.09, 95%CI-1.86 to-0.32, P=0.006) significantly reduced, and blood transfusion rate (RR=0.61, 95%CI 0.48 to 0.79, P=0.000 1) significantly reduced. Operation time (MD=-7.75, 95%CI-16.65 to 1.15, P=0.09) did not shorten. (3) There was no significant difference in the incidence of thrombotic complications between the tranexamic acid group and the control group (RR=0.92, 95%CI 0.47 to 1.82, P=0.81). CONCLUSION: Tranexamic acid can significantly reduce the perioperative blood loss of open spine surgery, shorten hospital stay, lower blood transfusion rate, and is safe and reliable. The use of tranexamic acid in open spinal surgery can promote enhanced recovery of patients after surgery; the initial dose of tranexamic acid is 10-15 mg/kg, maintenance dose 1.0-2.0 mg/kg per hour. It may be the best solution for intravenous tranexamic acid in open spine surgery.