, Volume 79, Issue 15, pp 1679–1688 | Cite as

The Safety and Efficacy of Tranexamic Acid in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

  • Dhwani Hariharan
  • Marco Mammi
  • Kelicia Daniels
  • Nayan Lamba
  • Kerilyn Petrucci
  • Christian D. Cerecedo-Lopez
  • Joanne Doucette
  • Alexander F. C. Hulsbergen
  • Stefania Papatheodorou
  • Linda S. Aglio
  • Timothy R. Smith
  • Rania A. MekaryEmail author
  • Hasan Zaidi
Systematic Review



Major spinal corrective surgeries can be associated with critical intra-operative blood loss. The objective of this systematic review and meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA), a commonly used antifibrinolytic agent, in adult spinal deformity (ASD) surgery, defined as fusion of five or more levels.


Articles from PubMed, Embase, Cochrane, and were screened using PRISMA guidelines through December 2018. Thromboembolic events, blood loss, and transfusion levels were primary outcomes of interest. Randomized controlled trials (RCTs) and observational studies (OBSs) with adult patients (≥ 18 years) were included. Continuous variables were analyzed using mean difference (MD) and categorical variables were analyzed using Peto odds ratio (OR), via random effects models.


Of the 604 articles screened, seven studies (two RCTs and five cohort studies) were included. Incidence of thromboembolic events was not statistically significantly different between TXA (1 event/19) and placebo (0 events/13) in the RCT (Peto OR = 1.41, 95% CI 0.05–37.2; 32 patients; 1 study) and in the OBSs (TXA [2 events/135] vs control [0 events/72]; Peto OR = 1.09, 95% CI 0.16–7.61; p-heterogeneity = 0.85; 207 patients; 3 studies). Data from OBSs showed that the pooled MD was statistically significantly lower in the TXA group compared with the control group for intraoperative blood loss (MD: − 620.2 mL, 95% CI − 1066.6 to − 173.7; p-heterogeneity = 0.14; 228 patients; 4 studies) and total transfusion volume (MD: − 958.2 mL, 95% CI − 1867.5 to − 49.0; p-heterogeneity = 0.23; 93 patients; 2 studies).


In this meta-analysis, TXA was not significantly associated with increased risk of thromboembolic events but was associated with lower intraoperative blood loss and lower total transfusion volumes in ASD surgery.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflict of Interest

The following authors declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript: Dhwani Hariharan, Marco Mammi, Kelicia Daniels, Nayan Lamba, Kerilyn Petrucci, Christian D Cerecedo-Lopez, Joanne Doucette, Alexander FC Hulsbergen, Stefania Papatheodorou, Linda S. Aglio, Timothy R. Smith, Rania A. Mekary, Hasan Zaidi.

Supplementary material

40265_2019_1185_MOESM1_ESM.pdf (41 kb)
Supplementary material 1 (PDF 40 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Dhwani Hariharan
    • 1
  • Marco Mammi
    • 2
    • 3
  • Kelicia Daniels
    • 1
  • Nayan Lamba
    • 2
  • Kerilyn Petrucci
    • 1
  • Christian D. Cerecedo-Lopez
    • 2
  • Joanne Doucette
    • 1
  • Alexander F. C. Hulsbergen
    • 2
  • Stefania Papatheodorou
    • 4
  • Linda S. Aglio
    • 2
    • 5
  • Timothy R. Smith
    • 2
  • Rania A. Mekary
    • 1
    • 2
    Email author
  • Hasan Zaidi
    • 2
  1. 1.School of PharmacyMCPHS UniversityBostonUSA
  2. 2.Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Neurosurgery Unit, Neuroscience DepartmentUniversity of TurinTurinItaly
  4. 4.Department of EpidemiologyHarvard TH Chan School of Public HealthBostonUSA
  5. 5.Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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