Advances in surgical hemostasis: a comprehensive review and meta-analysis on topical tranexamic acid in spinal deformity surgery

  • Nida FatimaEmail author
  • Megan E. Barra
  • Russel Joseph Roberts
  • Elie Massaad
  • Muhamed Hadzipasic
  • Ganesh M. Shankar
  • John H. Shin


Tranexamic acid (TXA) is an effective and commonly used hemostatic agent for perioperative blood loss in various surgical specialties. It is being increasingly used in spinal deformity surgery. We aimed to evaluate the safety and efficacy of topical TXA (tTXA) compared to both placebo and/or intravenous (IV) TXA in patients undergoing spinal deformity surgery. We conducted a systematic review of the electronic databases using different MeSH terms from January 1970 to August 2019. Pooled and subgroup analysis was performed using fixed and random-effect model based upon the heterogeneity (I2). A total of 609 patients (tTXA: n = 258, 42.4%) from 8 studies were included. We found that there was a statistically significant difference in terms of (i) postoperative blood loss [mean difference (MD) − 147.1, 95% CI − 189.5 to − 104.8, p < 0.00001], (ii) postoperative hemoglobin level (MD 1.09, 95% CI 0.45 to 1.72, p = 0.0008), (iii) operative time (MD 7.47, 95% CI 2.94 to 12.00, p < 0.00001), (iv) postoperative transfusion rate [odds ratio (OR) 0.39, 95% CI 0.20 to 0.78, p = 0.007], postoperative drain output (MD, − 184.0, 95% CI − 222.03 to − 146.04, p < 0.00001), and (v) duration of hospital stay (MD − 1.14, 95% CI − 1.44 to − 0.85, p < 0.00001) in patients treated with tTXA compared to the control group. However, there was no significant difference in terms of intraoperative blood loss (p = 0.13) and complications (p = 0.23) between the two comparative groups. Furthermore, low-dose (250–500 mg) tTXA (p < 0.00001) reduced postoperative blood loss more effectively compared to high-dose tTXA (1–3 g) (p = 0.001). Our meta-analysis corroborates the effectiveness and safety of tTXA in spinal deformity surgery.


Tranexamic acid Safety Efficacy Blood loss Spine fusion Spinal deformity Scoliosis 


Compliance with ethical standards

Conflict of interest

On behalf of all the authors, the corresponding authors affirm that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of NeurosurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of Clinical PharmacistMassachusetts General HospitalBostonUSA

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