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

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

doi:10.1155/2020/7403034

“…A plethora of studies has demonstrated TXA's effects in reducing blood loss and transfusion rates. 5 Although most studies focused on the intravenous and topical forms of TXA, 8,16 this is one of the first studies in the spine literature that compares IV versus PO formulations of TXA. We found no difference in the efficacy between the two routes of administration in both the primary outcome of hemoglobin drop and secondary outcomes.…”

Section: Discussionmentioning

confidence: 99%

Oral Is as Effective as Intravenous Tranexamic Acid at Reducing Blood Loss in Thoracolumbar Spinal Fusions

Fidai

¹

,

Washington

²

,

Bartol

³

et al. 2021

Spine

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Study Design. A prospective randomized trial at a university affiliated tertiary medical center between February 2017 and March 2020.Objective. The aim of this study was to compare perioperative blood loss in patients undergoing elective posterior thoracolumbar fusion who were treated with IV versus PO TXA. Summary of Background Data. The use of antifibrinolytic agents such as tranexamic acid (TXA) to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. Although evidence supports the use of intravenous (IV) and topical formulations of TXA in spine surgery, the use of oral (PO) TXA has not been studied. Methods. A total of 261 patients undergoing thoracolumbar fusion were randomized to receive 1.95 g of PO TXA 2 hours preoperatively or 2 g IV TXA (1 g before incision and 1 g before wound closure) intraoperatively. The sample was further stratified into three categories based on number of levels fused (oneto two-level fusions, three to five, and more than five). The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay. Equivalence analysis was performed with a two one-sided test.Results. One hundred thirty-seven patients received IV and 124 received PO TXA. The average age was 62 AE 13 years (mean AE SD), including 141 females and 120 males. Revision cases comprised of 67% of the total sample. Patient demographic factors were similar between groups except for weight, BMI, and preoperative platelet count. The mean reduction of hemoglobin was similar between IV and PO groups (3.56 vs. 3.28 g/dL, respectively; P ¼ 0.002, equivalence). IV TXA group had a higher transfusion rate compared to PO TXA group (22 patients [19%] vs. 12 patients [10%]; P ¼ 0.03). In addition, IV group had longer length of stay (LOS) than PO group (4.4 vs. 3.7 days; P ¼ 0.02). Conclusion. Patients treated with IV and PO TXA experienced the same perioperative blood loss after small and large spinal fusions. In subgroup analysis, the intermediate (three to five level) spinal fusions had less blood loss with PO TXA than IV TXA. Given its lower cost, PO TXA represents a superior alternative to IV TXA in patients undergoing elective posterior thoracolumbar fusion and may improve health care cost-efficiency in the studied population.

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“…The results of the pooled analysis showed that the significant effect of reducing perioperative blood loss and blood transfusion rate might make TXA the drug of choice. TXA, as an antifibrinolytic drug, is currently mainly used in orthopedic, cardiac, and spine surgery to treat or prevent excessive perioperative blood loss [ 6 ]. TXA was administered through a variety of routes, including IV, topical, and oral.…”

Section: Discussionmentioning

confidence: 99%

“…TXA, a synthetic lysine analogue, exerts an antifibrinolytic effect through binding to the lysine-binding sites on plasminogen molecules and inhibiting fibrinolysis [ 6 ]. Some clinical studies and meta-analyses show that intravenous (IV) TXA can reduce blood loss and allogeneic blood transfusion without the high risk of complications such as pulmonary embolism (PE), deep vein thrombosis (DVT), or other [ 1 – 5 , 7 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Xiong

¹

,

Wu

²

,

Zhang

³

et al. 2020

BioMed Research International

Self Cite

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Objective. To evaluate the efficacy and safety of different dose regimens of intravenous (IV) tranexamic acid (TXA) in adolescent spinal deformity surgery. Methods. Two researchers independently searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science to find studies that met the inclusion criteria. A meta-analysis was performed based on the guidelines of the Cochrane Reviewer’s Handbook. Results. Six randomized controlled trials (RCTs) and eleven non-RCTs were identified, including 1148 patients. According to different dose regimens of IV TXA, the included studies were divided into the high-dose group and the low-dose group. Compared with placebo, both groups had less total blood loss (TBL) (high dose: WMD = − 1737.55 , 95% CI: (-2247.16, -1227.94), P < 0.001 , I 2 = 0 % ; low dose: WMD = − 528.67 , 95% CI: (-666.06, -391.28), P < 0.001 , I 2 = 0 % ), intraoperative blood loss (IBL) (high dose: WMD = − 301.48 , 95% CI: (-524.3, -78.66), P = 0.008 , I 2 = 60.3 % ; low dose: WMD = − 751.14 , 95% CI: (-967.21, -535.08), P < 0.001 , I 2 = 0 % ), and blood transfusion rates (high dose: RR = 0.19 , 95% CI: (0.1, 0.37), P < 0.001 , I 2 = 0 % ; low dose: RR = 0.4 , 95% CI: (0.18, 0.91), P = 0.029 , I 2 = 57 % ). High-dose IV TXA use was associated with more vertebral fusion segments ( WMD = 0.53 , 95% CI: (0.23, 0.82), P < 0.001 , I 2 = 31.2 % ). Low-dose IV TXA use was associated with shorter operative time ( WMD = − 18.43 , 95% CI: (-26.68, -10.17), P < 0.001 , I 2 = 0 % ). Conclusion. High-dose and low-dose IV TXA were effective in reducing TBL, IBL, and blood transfusion rates without increasing complications in adolescent patients undergoing spinal deformity surgery. Low-dose IV TXA was effective in reducing the operative time. Both the high-dose and low-dose groups had similar preoperative and postoperative Hb levels compared to the control group.

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“…The heterogeneity was investigated by using the Q test and the I 2 test. The values of I 2 25%-50%, 50%-75%, and >75% were considered as low, moderate, and high heterogeneity, respectively [ 13 ]. We perform the random-effects model when I 2 > 50% and P < 0.1.…”

Section: Methodsmentioning

confidence: 99%

Rebamipide with Proton Pump Inhibitors (PPIs) versus PPIs Alone for the Treatment of Endoscopic Submucosal Dissection-Induced Ulcers: A Meta-analysis

Liu

¹

,

Xiong

²

,

Geng

³

et al. 2020

BioMed Research International

Self Cite

2

0

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Objective. To contrast the effect of rebamipide with proton pump inhibitors (PPIs) versus PPIs alone for the treatment of endoscopic submucosal dissection (ESD-) induced ulcers. Methods. PubMed, Embase, the Cochrane library, the WanFang database, and China National Knowledge Infrastructure (CNKI) were searched to identify studies that met the inclusion criteria. Results. Nine randomized controlled trials (RCTs) were recognized, including 1170 patients. In general, rebamipide plus PPIs acted better than PPIs alone against ESD-induced ulcers at four weeks ( RR = 1.42 , 95% CI: 1.13-1.78, P = 0.003 ) but showed no significant differences at eight weeks ( RR = 1.03 , 95% CI: 0.97-1.10, P = 0.315 ). The use of rebamipide plus PPIs was superior to PPIs alone for ESD-induced ulcers greater than 20 mm in size (20-40 mm: RR = 1.98 , 95% CI: 1.22-3.23, P = 0.006 ; >40 mm: RR = 5.14 , 95% CI: 1.49-17.74, P = 0.010 ). In addition, rebamipide plus PPI therapy was discovered to be significantly more effective than PPIs alone for lower ESD-induced ulcers ( RR = 1.82 , 95% CI: 1.04-3.20, P = 0.037 ). There were no significant differences between the treatment groups with the ulcer reduction rate. Conclusion. Evidences now available show rebamipide plus PPIs is practical for protecting against ESD-induced ulcers at four weeks but not at eight weeks, especially large ulcers (>20 mm). However, we still need more high-quality RCTs in the future to supplement our conclusions.

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

Cited by 15 publications

References 33 publications

Oral Is as Effective as Intravenous Tranexamic Acid at Reducing Blood Loss in Thoracolumbar Spinal Fusions

Oral Is as Effective as Intravenous Tranexamic Acid at Reducing Blood Loss in Thoracolumbar Spinal Fusions

Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Rebamipide with Proton Pump Inhibitors (PPIs) versus PPIs Alone for the Treatment of Endoscopic Submucosal Dissection-Induced Ulcers: A Meta-analysis

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