Skip to main content
Log in

Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The present meta-analysis aimed at assessing the effectiveness and safety of tranexamic acid (TXA) in reducing blood loss and transfusion in spinal surgery.

Methods

Systematic searches of all studies published through March 2012 were identified from PubMed, EMBase, Cochrane library, Science Direct, and other databases. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers searched and assessed the literature. Mean difference (MD) of blood loss and blood transfusions, risk ratios (RR) of transfusion rate and of deep vein thrombosis rate in the TXA-treated group versus placebo group were pooled throughout the study. The meta-analysis was conducted by RevMan 5.1 software.

Results

Six placebo-controlled RCTs encompassing 411 patients met the inclusion criteria for our meta-analysis. The use of TXA significantly reduced both total blood loss [MD = −285.35, 95 % CI (−507.03 to −63.67), P = 0.01] as well as the number of patients requiring blood transfusion [RR = 0.71, 95 % CI (0.54–0.92), P = 0.01]. None of the patients in the treatment group had deep-vein thrombosis (DVT) or pulmonary embolism.

Conclusions

Intravenous use of TXA for patients undergoing spinal surgery is effective and safe. It reduces total blood loss and the need for blood transfusion, particularly in the using of high dosage of TXA (≥15 mg/kg), yet does not increase the risk of postoperative DVT. Due to the limitation of the quality of the evidence currently available, high-quality RCTs are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Behrman MJ, Keim HA (1992) Perioperative red blood cell salvage in spine surgery. A prospective analysis. Clin Orthop Relat Res 278:51–57

    PubMed  Google Scholar 

  2. Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S (2000) Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine (Phila Pa 1976) 25(5):596–601

    Article  CAS  Google Scholar 

  3. Tate DE Jr, Friedman RJ (1992) Blood conservation in spinal surgery review of current techniques. Spine (Phila Pa 1976) 17(12):1450–1456

    Article  Google Scholar 

  4. Alter HJ, Klein HG (2008) The hazards of blood transfusion in historical perspective. Blood 112(7):2617–2626 (pii:112/7/2617)

    Article  PubMed  CAS  Google Scholar 

  5. Sandler SG, Yu H, Rassai N (2003) Risks of blood transfusion and their prevention. Clin Adv Hematol Oncol 1(5):307–313

    PubMed  Google Scholar 

  6. Varney SJ, Guest JF (2003) The annual cost of blood transfusions in the UK. Transfus Med 13(4):205–218 (pii: 443)

    Article  PubMed  CAS  Google Scholar 

  7. Zheng F, Cammisa FP Jr, Sandhu HS, Girardi FP, Khan SN (2002) Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976) 27(8):818–824

    Article  Google Scholar 

  8. Hardy JF, Desroches J (1992) Natural and synthetic antifibrinolytics in cardiac surgery. Can J Anaesth 39(4):353–365. doi:10.1007/BF03009046

    Article  PubMed  CAS  Google Scholar 

  9. Arnold DM, Fergusson DA, Chan AK, Cook RJ, Fraser GA, Lim W, Blajchman MA, Cook DJ (2006) Avoiding transfusions in children undergoing cardiac surgery: a meta-analysis of randomized trials of aprotinin. Anesth Analg 102(3):731–737. doi:10.1213/01.ane.0000194954.64293.61

    Article  PubMed  Google Scholar 

  10. Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S (2006) Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology 105(5):1034–1046. doi:10.1097/00000542-200611000-00026

    Article  PubMed  Google Scholar 

  11. Kebaish KM, Awad JN (2004) Spinal epidural hematoma causing acute cauda equina syndrome. Neurosurg Focus 16(6):e1 (pii: 160601)

    Article  PubMed  Google Scholar 

  12. Sokolowski MJ, Garvey TA, Perl J 2nd, Sokolowski MS, Cho W, Mehbod AA, Dykes DC, Transfeldt EE (2008) Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976) 33(1):108–113. doi:10.1097/BRS.0b013e31815e39af

    Article  Google Scholar 

  13. Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 16(11):1277–1282

    Article  CAS  Google Scholar 

  14. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83(8):713–721

    PubMed  Google Scholar 

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. doi:10.1136/bmj.327.7414.557

    Article  PubMed  Google Scholar 

  16. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188. doi:10.1016/0197-2456(86)90046-2

    Article  PubMed  CAS  Google Scholar 

  17. Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127(9):820–826

    Article  PubMed  CAS  Google Scholar 

  18. Elwatidy S, Jamjoom Z, Elgamal E, Zakaria A, Turkistani A, El-Dawlatly A (2008) Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine (Phila Pa 1976) 33(24):2577–2580. doi:10.1097/BRS.0b013e318188b9c5

    Article  Google Scholar 

  19. Farrokhi MR, Kazemi AP, Eftekharian HR, Akbari K (2011) Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial. J Neurosurg Anesthesiol 23(4):290–296. doi:10.1097/ANA.0b013e31822914a1

    Article  PubMed  Google Scholar 

  20. Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM (2001) A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 93(1):82–87

    Article  PubMed  CAS  Google Scholar 

  21. Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F (2005) Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery. Anesthesiology 102(4):727–732. doi:10.1097/00000542-200504000-00006

    Article  PubMed  CAS  Google Scholar 

  22. Tsutsumimoto T, Shimogata M, Ohta H, Yui M, Yoda I, Misawa H (2011) Tranexamic acid reduces perioperative blood loss in cervical laminoplasty: a prospective randomized study. Spine (Phila Pa 1976) 36(23):1913–1918. doi:10.1097/BRS.0b013e3181fb3a42

    Article  Google Scholar 

  23. Wong J, El Beheiry H, Rampersaud YR, Lewis S, Ahn H, De Silva Y, Abrishami A, Baig N, McBroom RJ, Chung F (2008) Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg 107(5):1479–1486. doi:10.1213/ane.0b013e3181831e44

    Article  PubMed  Google Scholar 

  24. Tobias JD (2004) Strategies for minimizing blood loss in orthopedic surgery. Semin Hematol 41(1 Suppl 1):145–156 (pii: S0037196303003196)

    Article  PubMed  Google Scholar 

  25. Endres S, Heinz M, Wilke A (2011) Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study. BMC Surg 11:29. doi:10.1186/1471-2482-11-29

    Article  PubMed  CAS  Google Scholar 

  26. Yagi M, Hasegawa J, Nagoshi N, Iizuka S, Kaneko S, Fukuda K, Takemitsu M, Shioda M, Machida M (2012) Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 37(21):E1336–E1342. doi:10.1097/BRS.0b013e318266b6e5

    Article  Google Scholar 

  27. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA, Ker K (2011) Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev (1):CD001886 doi:10.1002/14651858.CD001886.pub3

  28. Gill JB, Chin Y, Levin A, Feng D (2008) The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Jt Surg Am 90(11):2399–2407. doi:10.2106/JBJS.G.01179

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Dr Claudia Juzi for her helping with language and are grateful for the support by the National Natural Science Foundation of China (Grant 21205087) and the Tianjin Health Bureau Science and Technology Foundation (No. 2011kz117).

Conflict of interest

Each author certifies that he has no commercial associations that might pose a conflict of interest related to the submitted article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xin-Long Ma.

Additional information

Zhi-Jun Li and Xin Fu contributed equally to the study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, ZJ., Fu, X., Xing, D. et al. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J 22, 1950–1957 (2013). https://doi.org/10.1007/s00586-013-2774-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2774-9

Keywords

Navigation