Intravenous Administration of Tranexamic Acid Significantly Reduces Visible and Hidden Blood Loss Compared with Its Topical Administration for Double-Segment Posterior Lumbar Interbody Fusion: A Single-Center, Placebo-Controlled, Randomized Trial

Mu, Xiaoping; Wei, Jianxun; Wang, Chenglong; Ou, Yufu; Yin, Dong; Liang, Bin; Qiu, Dezan; Li, Zhuhai

doi:10.1016/j.wneu.2018.10.154

Cited by 35 publications

(48 citation statements)

References 21 publications

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“…We excluded letter or review, and records for which data could not be extracted according to the inclusion criteria. Finally, eight RCTs [6][7][8][9][10][11][12][13] met the criteria for data extraction and meta-analysis. Figure 1 shows the search strategy and selection process [6][7][8][9][10][11][12][13].…”

Section: Selection Of Studiesmentioning

confidence: 99%

“…All studies compared the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. e number of patients in the intravenous group (333 patients) was higher than in the topical group (327 patients) [6][7][8][9][10][11][12][13]. e surgical method used in four studies [6,7,9,11] was posterior lumbar decompression and fusion.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…ese studies include a total of five surgical methods, all of which were nondeformity spine surgery [6][7][8][9][10][11][12][13]. In the included studies, Wang et al [8] claimed that in the intravenous group, intravenous drip of TXA at a dose of 15 mg/kg was given half an hour before the operation.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In the topical group, intraoperative topical application of 3 g TXA was prescribed before wound closure [8]. Mu et al [7] claimed that in the intravenous group, intravenous drip of TXA at a loading dose of 15 mg/kg was given half an hour before the operation, and at a maintenance dose of 1 mg/kg during surgery. In the topical group, topical application of 1 g TXA was prescribed before wound closure [7].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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]. Recently, some studies have reported a comparison of the efficacy and safety of intravenous versus topical administration of TXA during spine surgery [6][7][8][9][10][11][12][13]. However, the optimal administration route of TXA remains controversial during spine surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Xiong

Liu

et al. 2020

BioMed Research International

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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<0.0001). 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.

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Section: Selection Of Studiesmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Xiong

Liu

et al. 2020

BioMed Research International

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Topical tranexamic acid (TXA) is non-inferior to intravenous TXA in adult spine surgery: a meta-analysis

Mitha,

Colan,

Hernandez-Rovira

et al. 2024

Neurosurg Rev

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Intravenous Administration of Tranexamic Acid Significantly Reduces Visible and Hidden Blood Loss Compared with Its Topical Administration for Double-Segment Posterior Lumbar Interbody Fusion: A Single-Center, Placebo-Controlled, Randomized Trial

Cited by 35 publications

References 21 publications

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

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

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Topical tranexamic acid (TXA) is non-inferior to intravenous TXA in adult spine surgery: a meta-analysis

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