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

Bao, Xianguo; Lü, Haitao; Gao, Zengxin; Wu, Zhanpo; Chen, Youmin; Chen, Yingjun; Cheng, Qinghua

doi:10.1155/2022/9406497

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…However, there is still a concern about the safety of high dose of TXA in surgery patients. [67] Bao et al [68] compared the efficacy and safety of TXA in spinal surgery and results found that TXA significantly reduce perioperative blood loss without increasing the thrombosis events. Thus, TXA can be applied for reducing blood loss in spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

et al. 2023

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Background: Significant blood loss is still one of the most frequent issues in spinal surgery. There were different hemostatic methods to prevent blood loss during spinal surgery. However, the optimal hemostatic therapy for spinal surgery is controversial. The purpose of this study was to assess the efficacy and safety of different hemostatic therapies in spinal surgery. Methods: Two independent reviewers conducted electronic literature searches in 3 electronic databases (PubMed, Embase, and Cochrane library database) as well as a manual search to identify eligible clinical studies from inception to Nov 2022. Studies that including different hemostatic therapy (tranexamic acid [TXA], epsilon-acetyl aminocaproic acid [EACA], and aprotinin [AP]) for spinal surgery were included. The Bayesian network meta-analysis was performed with a random effects model. The surface under the cumulative ranking curve (SUCRA) analysis was performed to determine the ranking order. All analyses were performed by R software and Stata software. P value less than .05 was identified as statistically significant. Results: Finally, a total of 34 randomized controlled trials met the inclusion criteria and finally included in this network meta-analysis. The SUCRA shows that TXA ranked first (SUCRA, 88.4%), AP ranked second (SUCRA, 71.6%), EACA ranked third (SUCRA, 39.9%), and placebo ranked the last (SUCRA, 0.3%) as for total blood loss. The SUCRA shows that TXA ranked first (SUCRA, 97.7%), AP ranked second (SUCRA, 55.8%), EACA ranked third (SUCRA, 46.2%), and placebo ranked the last (SUCRA, 0.2%) for need for transfusion. Conclusions: TXA appears optimal in the reduction of perioperative bleeding and blood transfusion during spinal surgery. However, considering the limitations in this study, more large-scale, well-designed randomized controlled trials are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

et al. 2023

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“…This article has been retracted by Hindawi following an investigation undertaken by the publisher [ 1 ]. This investigation has uncovered evidence of one or more of the following indicators of systematic manipulation of the publication process: Discrepancies in scope Discrepancies in the description of the research reported Discrepancies between the availability of data and the research described Inappropriate citations Incoherent, meaningless and/or irrelevant content included in the article Peer-review manipulation …”

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confidence: 99%

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confidence: 99%

Retracted: Meta‐Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery

Medicine¹

2023

Computational and Mathematical Methods in Medicine

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“…V posledním desetiletí strmě narůstá počet studií, které hodnotí efekt tranexamové kyseliny na redukci perioperačního krvácení u konkrétních chirurgických výkonů různých oborů, jakožto i u spinálních operací. I přes to že již řada metaanalýz potvrzuje příznivý vliv tranexamové kyseliny na redukci krevní ztráty u spinálních operací (2,6,12,17,18), několik málo studií ale takto jednoznačný příznivý vliv nepotvrdilo (3,10). Otázkou stále zůstává dávka, způsob podání a typ výkonu, kdy je podání tranexamové kyseliny přínosné.…”

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Effects of Tranexamic Acid on Perioperative Blood Loss and Wound Hematoma Development in Lumbar Spine Surgery: a Prospective Randomized Study

Stejskal¹,

Trnka²,

Hrabálek³

et al. 2023

ACHOT

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PURPOSE OF THE STUDYTranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss reduction in specific surgical procedures. The aim of our study was to evaluate the effect of tranexamic acid on reducing intraoperative blood loss, postoperative blood loss into the drain, total blood loss, transfusion requirements, and development of symptomatic wound hematoma in conventional single-level lumbar decompression and stabilization. MATERIAL AND METHODSThe study included patients who had undergone a traditional open lumbar spine surgery in the form of single-level decompression and stabilisation. The patients were randomized into two groups. The study group received a 15 mg/kg dose of tranexamic acid intravenously during the induction of anaesthesia and then again 6 hours later. No tranexamic acid was administered to the control group. In all patients, intraoperative blood loss, postoperative blood loss into the drain, and therefore also total blood loss, transfusion requirements and potential development of a symptomatic postoperative wound hematoma requiring surgical evacuation were recorded. The data of the two groups were compared. RESULTSThe cohort includes 162 patients, 81 in the study group and the same number in the control group. In the intraoperative blood loss assessment, no statistically significant difference between the two groups was observed; 430 (190-910) mL vs. 435 (200-900) mL. In case of post-operative drain blood loss, a statistically significantly lower volume was reported after the tranexamic acid administration; 405 (180-750) mL vs. 490 (210-820) mL. When evaluating the total blood loss, a statistically significant difference was also confirmed, namely in favour of the tranexamic acid; 860 (470-1410) mL vs. 910 (500-1420) mL. The reduction of total blood loss did not result in a difference in the number of administered transfusions; transfusions were given to 4 patients in each group. A postoperative wound hematoma requiring surgical evacuation developed in 1 patient in the group with the tranexamic acid and in 4 patients in the control group, but the difference was not statistically significant with respect to the insufficient group size. No patient in our study experienced complications associated with tranexamic acid application. DISCUSSIONThe beneficial effect of tranexamic acid on reducing blood loss in lumbar spine surgeries has already been confirmed by numerous meta-analyses. The question remains in what types of procedures, at what dose and route of administration its effect is significant. To date, most of the studies have explored its effect in multi-level decompressions and stabilizations. Raksakietisak et al., for instance, report significant reduction in total blood loss from 900 (160, 4150) mL to 600 (200, 4750) mL following an intravenous injection of 2 bolus doses of 15 mg/kg tranexamic acid. In less extensive spinal surgeries, the effect of t...

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

Cited by 3 publications

References 13 publications

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

Comparative efficacy and safety of different hemostatic medications during spinal surgery: A network meta-analysis

Retracted: Meta‐Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery

Effects of Tranexamic Acid on Perioperative Blood Loss and Wound Hematoma Development in Lumbar Spine Surgery: a Prospective Randomized Study

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