Association of tranexamic acid with decreased blood loss in patients undergoing laminectomy and fusion with posterior instrumentation: a systematic review and meta-analysis

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  • 1 Department of Neurological Surgery, University of California, Irvine, Orange, California;
  • | 2 Case Western Reserve University School of Medicine, Cleveland, Ohio;
  • | 3 Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland;
  • | 4 Department of Neurosurgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii;
  • | 5 Keck School of Medicine of University of Southern California, Los Angeles, California;
  • | 6 Medical Scientist Training Program, California Institute of Technology, Pasadena, California;
  • | 7 College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas;
  • | 8 University of Southern California, Los Angeles, California;
  • | 9 Department of Neurological Surgery, Geisinger Health System, Danville, Pennsylvania; and
  • | 10 Department of Neurological Surgery, University of California, San Diego, La Jolla, California
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OBJECTIVE

Tranexamic acid (TXA) is an antifibrinolytic agent associated with reduced blood loss and mortality in a wide range of procedures, including spine surgery, traumatic brain injury, and craniosynostosis. Despite this wide use, the safety and efficacy of TXA in spine surgery has been considered controversial due to a relative scarcity of literature and lack of statistical power in reported studies. However, if TXA can be shown to reduce blood loss in laminectomy with fusion and posterior instrumentation, more surgeons may include it in their armamentarium. The authors aimed to conduct an up-to-date systematic review and meta-analysis of the efficacy of TXA in reducing blood loss in laminectomy and fusion with posterior instrumentation.

METHODS

A systematic review and meta-analysis, abiding by PRISMA guidelines, was performed by searching the databases of PubMed, Web of Science, and Cochrane. These platforms were queried for all studies reporting the use of TXA in laminectomy and fusion with posterior instrumentation. Variables retrieved included patient demographics, surgical indications, involved spinal levels, type of laminectomy performed, TXA administration dose, TXA route of administration, operative duration, blood loss, blood transfusion rate, postoperative hemoglobin level, and perioperative complications. Heterogeneity across studies was evaluated using a chi-square test, Cochran’s Q test, and I2 test performed with R statistical programming software.

RESULTS

A total of 7 articles were included in the qualitative study, while 6 articles featuring 411 patients underwent statistical analysis. The most common route of administration for TXA was intravenous with 15 mg/kg administered preoperatively. After the beginning of surgery, TXA administration patterns were varied among studies. Blood transfusions were increased in non-TXA cohorts compared to TXA cohorts. Patients administered TXA demonstrated a significant reduction in blood loss (mean difference −218.44 mL; 95% CI −379.34 to −57.53; p = 0.018). TXA administration was not associated with statistically significant reductions in operative durations. There were no adverse events reported in either the TXA or non-TXA patient cohorts.

CONCLUSIONS

TXA can significantly reduce perioperative blood loss in cervical, thoracic, and lumbar laminectomy and fusion procedures, while demonstrating a minimal complication profile.

ABBREVIATIONS

IV = intravenously; LOS = length of stay; RCT = randomized controlled trial; TXA = tranexamic acid.

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