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

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Abstract

Objectives

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.

Methods

Articles from PubMed, Embase, Cochrane, and clinicaltrials.gov 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.

Results

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).

Conclusion

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.

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Author notes

  1. Dhwani Hariharan and Marco Mammi are co-first authors.

  2. Rania A. Mekary and Hasan Zaidi are co-senior authors.

Authors and Affiliations

  1. School of Pharmacy, MCPHS University, Boston, MA, 02115, USA

    Dhwani Hariharan, Kelicia Daniels, Kerilyn Petrucci, Joanne Doucette & Rania A. Mekary

  2. Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Marco Mammi, Nayan Lamba, Christian D. Cerecedo-Lopez, Alexander F. C. Hulsbergen, Linda S. Aglio, Timothy R. Smith, Rania A. Mekary & Hasan Zaidi

  3. Neurosurgery Unit, Neuroscience Department, University of Turin, Turin, Italy

    Marco Mammi

  4. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

    Stefania Papatheodorou

  5. Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Linda S. Aglio

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  1. Dhwani Hariharan
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Correspondence to Rania A. Mekary.

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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.

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Hariharan, D., Mammi, M., Daniels, K. et al. The Safety and Efficacy of Tranexamic Acid in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis. Drugs 79, 1679–1688 (2019). https://doi.org/10.1007/s40265-019-01185-y

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