Intravenous versus topical tranexamic acid in spinal surgery: a systematic review and meta-analysis.
Intravenous
Spinal surgery
Topical
Tranexamic acid
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
27 Aug 2024
27 Aug 2024
Historique:
received:
27
06
2024
accepted:
06
08
2024
medline:
28
8
2024
pubmed:
28
8
2024
entrez:
27
8
2024
Statut:
epublish
Résumé
The administration of tranexamic acid (TXA) during spinal surgery has been shown to reduce blood loss. However, the efficacy and safety of intravenous TXA (ivTXA) and topical TXA (tTXA) are poorly documented. The present meta-analysis aimed to compare the efficacy and safety of ivTXA and tTXA administration in spinal surgery. Potentially relevant academic articles were identified from PubMed, Ovid, Cochrane Library, CNKI database, and Wanfang Data from the date of inception until March 1, 2024. Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) were included in our meta-analysis if they compared the efficacy and safety of ivTXA versus tTXA administration during spinal surgery. Secondary sources were identified from the references of the included literature. The meta-analysis was performed in accordance with the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Data were summarized using RevMan 5.3 software from Denmark. Four RCTs and one non-RCT met our inclusion criteria. The pooled outcomes demonstrated that ivTXA groups compared with tTXA groups had significantly less amount of total blood loss [weighted mean difference (WMD)=-159.55, 95% CI (-181.91,-137.19), P < 0.00001], hidden blood loss [WMD=-132.27, 95% CI (-159.81, -104.72), P < 0.00001], intraoperative blood loss [WMD=-86.22, 95% CI (-99.13, -73.31), P < 0.00001, I Our meta-analysis demonstrated that ivTXA was more effective than tTXA in inducing hemostatic effect during spinal surgery. However, the risk of a thrombotic event was not different between the two administration methods of TXA. More high quality RCTs are needed to further confirm our conclusions.
Sections du résumé
BACKGROUND
BACKGROUND
The administration of tranexamic acid (TXA) during spinal surgery has been shown to reduce blood loss. However, the efficacy and safety of intravenous TXA (ivTXA) and topical TXA (tTXA) are poorly documented. The present meta-analysis aimed to compare the efficacy and safety of ivTXA and tTXA administration in spinal surgery.
METHODS
METHODS
Potentially relevant academic articles were identified from PubMed, Ovid, Cochrane Library, CNKI database, and Wanfang Data from the date of inception until March 1, 2024. Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) were included in our meta-analysis if they compared the efficacy and safety of ivTXA versus tTXA administration during spinal surgery. Secondary sources were identified from the references of the included literature. The meta-analysis was performed in accordance with the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Data were summarized using RevMan 5.3 software from Denmark.
RESULTS
RESULTS
Four RCTs and one non-RCT met our inclusion criteria. The pooled outcomes demonstrated that ivTXA groups compared with tTXA groups had significantly less amount of total blood loss [weighted mean difference (WMD)=-159.55, 95% CI (-181.91,-137.19), P < 0.00001], hidden blood loss [WMD=-132.27, 95% CI (-159.81, -104.72), P < 0.00001], intraoperative blood loss [WMD=-86.22, 95% CI (-99.13, -73.31), P < 0.00001, I
CONCLUSION
CONCLUSIONS
Our meta-analysis demonstrated that ivTXA was more effective than tTXA in inducing hemostatic effect during spinal surgery. However, the risk of a thrombotic event was not different between the two administration methods of TXA. More high quality RCTs are needed to further confirm our conclusions.
Identifiants
pubmed: 39192283
doi: 10.1186/s13018-024-04989-1
pii: 10.1186/s13018-024-04989-1
doi:
Substances chimiques
Tranexamic Acid
6T84R30KC1
Antifibrinolytic Agents
0
Types de publication
Journal Article
Systematic Review
Meta-Analysis
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
512Subventions
Organisme : No
ID : NO
Organisme : No
ID : NO
Organisme : No
ID : NO
Organisme : No
ID : NO
Organisme : No
ID : NO
Informations de copyright
© 2024. The Author(s).
Références
Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S. Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine (Philadelphia Pa 1976). 2000;25(5):596–601.
doi: 10.1097/00007632-200003010-00010
Theusinger OM, Spahn DR. Perioperative blood conservation strategies for major spine surgery. Best Pract Res Clin Anaesthesiol. 2016;30:41–52.
doi: 10.1016/j.bpa.2015.11.007
pubmed: 27036602
Janssen SJ, Braun Y, Wood KB, Cha TD, Schwab JH. Allogeneic blood transfusions and postoperative infections after lumbar spine surgery. Spine J. 2015;15:901–9.
doi: 10.1016/j.spinee.2015.02.010
pubmed: 25681582
Cardone D, Klein AA. Perioperative blood conservation. Eur J Anaesthesiol. 2009;26:722–9.
doi: 10.1097/EJA.0b013e32832c5280
pubmed: 19448549
Hu SS. Blood loss in adult spinal surgery. Eur Spine J. 2004;13(Suppl 1):53–5.
Hui S, Xu D, Ren Z, et al. Can txanexamic acid conserve blood and save operative time in spinal surgeries? A meta-analysis. Spine J. 2018;18:1325–37.
doi: 10.1016/j.spinee.2017.11.017
pubmed: 29246849
Wong J, Beheiry EI, Rampersaud H, Lewis YR, Ahn S, De Silva H, Abrishami Y, Baig A, McBroom N. Chung F:tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg. 2008;107:1479–86.
doi: 10.1213/ane.0b013e3181831e44
pubmed: 18931202
Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia. 2015;70:50–e18.
doi: 10.1111/anae.12910
pubmed: 25440395
Zhang P, Liang Y, Chen P, Fang Y, He J, Wang J. Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2017;18(1):90.
doi: 10.1186/s12891-017-1429-0
pubmed: 28222709
pmcid: 5320770
Ngichabe S, Obura T, Stones W. Intravenous tranexamic acid as an adjunct haemostat to ornipressin during open myomectomy. A randomized double blind placebo controlled trial. Ann Surg Innov Res. 2015;9:1–6.
doi: 10.1186/s13022-015-0017-y
Bonis MD, Cavaliere F, Alessandrini F, et al. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study. J Thorac Cardiovasc Surg. 2000;119:575–80.
doi: 10.1016/S0022-5223(00)70139-5
pubmed: 10694619
Wei Luo Ru-xin, Han Jiangand Xin-long Ma. The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis. J Orthop Surg Res. 2018;13(1):96.
doi: 10.1186/s13018-018-0815-0
pubmed: 29690892
pmcid: 5937828
Fatima N, Barra ME, Roberts RJ, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Advances in surgical hemostasis: a comprehensive review and meta-analysis on topical tranexamic acid in spinal deformity surgery. Neurosurg Rev. 2020;14.
Yerneni K, Burke JF, Tuchman A, Li XJ, Metz LN, Lehman RA Jr, Lenke LG, Tan LA. Topical tranexamic acid in spinal surgery: a systematic review and meta-analysis. J Clin Neurosci. 2019;61:114–9.
doi: 10.1016/j.jocn.2018.10.121
pubmed: 30401569
Hui S, Tao L, Mahmood F, Xu D, Ren Z, Chen X, Sheng L, Zhuang Q, Li S, Huang Y. Tranexamic acid in reducing gross hemorrhage and transfusions of spine surgeries (TARGETS): Study protocol for a prospective, randomized, double-blind, non-inferiority trial. Trials. 2019,12;20(1):125.
ZhangP, Liang Y, Chen P, Fang Y, He J, Wang J. Intravenous versus topical tranexamic acid in primary total hip replacement: a meta-analysis. Medicine(Baltimore). 2016;95(50):e5573.
MENG, Xian-yong H, Changbo. Yang Xin-ming. Effects of tranexamic acid on lumbar surgery by different ways of administration. J Hebei Med Univ. 2017;38(1):29–37.
Mu X, Wei J, Wang C, Ou Y, Yin D, Liang B, Qiu D, Li Z. Intravenous administration of tranexamic acid significantly reduces visible and hidden blood loss compared with its topical administration for double-segment posterior lumbar Interbody Fusion: a single-center, placebo-controlled, randomized trial. World Neurosurg. 2019;122:e821–7.
doi: 10.1016/j.wneu.2018.10.154
pubmed: 30391759
Ou Y, Wei J, Li R, Liang B, Qiu D, Wei M, Mu X, Li Z. Clinical research of combined intravenous administration and topical application of tranexamic acid to a surgical wound during posterior lumbar fusion. Surg Innov. 2018;25(2):128–35.
doi: 10.1177/1553350617751449
pubmed: 29303065
Wang X, Yang R, Sun H, Zhang Y. Different effects of intravenous, topical, and combined application of tranexamic acid on patients with thoracolumbar fracture. World Neurosurg. 2019;127:e1185–9.
doi: 10.1016/j.wneu.2019.04.095
pubmed: 31004853
Han Z, Ji P, Yun-qin R, Peng Z, Hong Y. Effect of local application of tranexamic acid on coagulation and fibrinolysis in patients undergoing spinal surgery. Med J Chin PLA. 2019;44(5):405–11.
Elgafy H, Bransford RJ, McGuire RA, Dettori JR, Fischer D. Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine (Philadelphia Pa 1976). 2010;35(9 Suppl):547–56.
WHO Expert Committee on the Selection and Use of Essential Medicines, Summary of the report of the 18th meeting of the WHO Expert Committee on the Selection and Use of Essential Medicines. 2011. http://www.who.int/selection_medicines/committees/TRS_web_summary.pdf . Accessed 20 Mar 2015.
Alshryda S, Mason J, Vaghela M, et al. Topical (intraarticular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg Am. 2013;95:1961–8.
doi: 10.2106/JBJS.L.00907
pubmed: 24196466
Endress S, Heinz M, Wilke A. 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. 2011;11:29.
doi: 10.1186/1471-2482-11-29
Aguilera X, Martinez-Zapata MJ, Hinarejos P, et al. Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg. 2015;135:1017–25.
doi: 10.1007/s00402-015-2232-8
pubmed: 25944156
Zufferey Y, Merquiol, Laporte S. (2006) Do anti-fibrinolytics reduce allogenic blood transfusion in orthopedic surgery？Anesthesiology. 2006,105: 1034–1046.
Ren Z, Li S, Sheng L, Zhuang Q, Li Z, Xu D, Chen X, Jiang P, Zhang X. Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: a retrospective study. Med (Baltim). 2017;96(42):e8233.
doi: 10.1097/MD.0000000000008233
Luo W, Sun RX, Jiang H, Ma XL. The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis. J Orthop Surg Res. 2018;24(1):96.
doi: 10.1186/s13018-018-0815-0
Yang B, Li H, Wang D, He X, Zhang C, Yang P. Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS ONE. 2013;8(2):e55436.
doi: 10.1371/journal.pone.0055436
pubmed: 23424632
pmcid: 3570541
Jaszczyk M, Kozerawski D, Kazimierczak A, et al. Effect of single preoperative dose of tranexamic acid on blood loss and transfusion in hip arthroplasty. Ortop Traumatol Rehabil. 2015;17:265–73.
doi: 10.5604/15093492.1162426
pubmed: 26248628
Wind TC, Bareld WR, Moskal JT. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty. J Arthroplasty. 2014;29:387–9.
doi: 10.1016/j.arth.2013.05.026
pubmed: 23790499