Effect of intravenous tranexamic acid on perioperative bleeding and transfusion in spine surgery: systematic review and meta-analysis of randomized controlled trials

ABSTRACT

BACKGROUND: This study aimed to systematically review the literature investigating the effect of intravenous (IV) tranexamic acid (TXA) on the perioperative blood loss and amount of transfused blood in patients who underwent spine surgery under general anesthesia. METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched for studies published up to June 2017. Randomized controlled trials comparing the intervention of tranexamic acid use with a placebo in corrective spine fusion surgery were included. Outcome measures included intraoperative and postoperative blood loss and perioperative blood transfusion volume. We also conducted subgroup analyses according to the dose of administration of intervention drug. RESULTS: In total, 12 studies involving 875 patients were included in the final analysis. Blood loss decreased in patients treated with perioperative IV TXA by a mean volume of 189.58 ml intraoperatively (95% confidence interval [CI] 135.82 to 243.34 ml, P < 0.001; I² = 74%), 121.04 ml postoperatively (95% CI 84.92 to 157.17 ml, P < 0.001; I² = 0%), and 285.97 ml in total (95% CI 190.70 to 381.23 ml, P < 0.001; I² = 0%). Perioperative transfusion volume also decreased by 162.10 ml in patients who received IV TXA (95% CI 31.77 to 292.44 ml, P = 0.010; I² = 47%). CONCLUSIONS: Blood loss was reduced in patients who were administered TXA during spine surgery. Additionally, the perioperative volume of blood transfusion decreased in patients who received TXA. Further research is required to confirm the optimal dosage and timing of TXA usage.