Meta-Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery

OBJECTIVE: The safety and effectiveness of topical tranexamic acid in spinal surgery has not yet been reached, and further research is needed to confirm it. This study is aimed at detecting the effectiveness and safety on the tranexamic acid in spinal surgery. METHODS: The Cochrane Library, PubMed, Embase, CNKI, and other databases were searched. The search time was from 2016 to 2019. All randomized controlled trials comparing the topical tranexamic acid group and the control group were collected. The experimental group used topical application. Tranexamic acid was used to treat bleeding after spinal surgery. The control group was no tranexamic acid or isotonic saline. The total bleeding, blood transfusion rate, and the occurrence of deep vein thrombosis were compared between the two groups. Rev Man 5.2.0 software was used for meta-analysis. RESULTS: A total of 8 randomized controlled trials were included, including 884 patients. Meta-analysis results showed that the total bleeding volume of the tranexamic acid group was lower than that of the control group, and the difference was statistically significant weighted mean difference ((WMD) = –360.27 mL, 95% confidence interval (CI) (–412.68, –307.87) mL, P < 0.00001). The blood transfusion rate in the tranexamic acid group was lower than that in the control group (odds ratio (OR) = 0.22, 95% CI (0.14, 0.33), P < 0.00001). There was no significant difference in the incidence of deep vein thrombosis between the two groups: OR = 1.48, 95% CI (0.41, 5.34), P = 0.55. CONCLUSION: Tranexamic acid can significantly reduce perioperative total blood loss, intraoperative blood loss, and blood transfusion rate during spinal surgery but has no significant effect on blood transfusion and thrombosis.