Anesth Pain Med.  2019 Apr;14(2):141-151. 10.17085/apm.2019.14.2.141.

Effect of intravenous tranexamic acid on perioperative bleeding and transfusion in spine surgery: systematic review and meta-analysis of randomized controlled trials

• Lee D
• Choi SJ
• Lee WY
• Kim KM
• Kim MC
• Lee S

• KMID: 2447961
• DOI: http://doi.org/10.17085/apm.2019.14.2.141

Abstract

BACKGROUND
This study aimed to systematically review the literature investigating the effect of intravenous (IV) tranexamic acid (TXA) on the perioperative blood loss and amount of transfused blood in patients who underwent spine surgery under general anesthesia.
METHODS
MEDLINE, EMBASE, and CENTRAL databases were searched for studies published up to June 2017. Randomized controlled trials comparing the intervention of tranexamic acid use with a placebo in corrective spine fusion surgery were included. Outcome measures included intraoperative and postoperative blood loss and perioperative blood transfusion volume. We also conducted subgroup analyses according to the dose of administration of intervention drug.
RESULTS
In total, 12 studies involving 875 patients were included in the final analysis. Blood loss decreased in patients treated with perioperative IV TXA by a mean volume of 189.58 ml intraoperatively (95% confidence interval [CI]: 135.82 to 243.34 ml, P < 0.001; I² = 74%), 121.04 ml postoperatively (95% CI: 84.92 to 157.17 ml, P < 0.001; I² = 0%), and 285.97 ml in total (95% CI: 190.70 to 381.23 ml, P < 0.001; I² = 0%). Perioperative transfusion volume also decreased by 162.10 ml in patients who received IV TXA (95% CI: 31.77 to 292.44 ml, P = 0.010; I² = 47%).
CONCLUSIONS
Blood loss was reduced in patients who were administered TXA during spine surgery. Additionally, the perioperative volume of blood transfusion decreased in patients who received TXA. Further research is required to confirm the optimal dosage and timing of TXA usage.

Keyword

Anesthesia; Blood transfusion; Hemorrhage; Spine; Tranexamic acid

MeSH Terms

Anesthesia
Anesthesia, General
Blood Transfusion
Hemorrhage*
Humans
Outcome Assessment (Health Care)
Postoperative Hemorrhage
Spine*
Tranexamic Acid*
Tranexamic Acid

Figure

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  Fig. 1 Flow diagram for selection of relevant studies in meta-analysis. RCT: randomized controlled trial, TXA: tranexamic acid.

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  Fig. 2 Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

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  Fig. 3 Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

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  Fig. 4 Forest plot diagram showing the effect of tranexamic acid (TXA) on intraoperative blood loss. SD: standard deviation, IV: intravenous, CI: confidence interval, TIVA: total intravenous anesthesia.

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  Fig. 5 Forest plot diagram showing the effect of tranexamic acid (TXA) on postoperative blood loss. SD: standard deviation, IV: intravenous, CI: confidence interval.

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  Fig. 6 Forest plot diagram showing the effect of tranexamic acid (TXA) on total perioperative blood loss. SD: standard deviation, IV: intravenous, CI: confidence interval.

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  Fig. 7 Forest plot diagram showing the effect of tranexamic acid (TXA) on transfusion volume. SD: standard deviation, IV: intravenous, CI: confidence interval.

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  Fig. 8 Funnel plot to assess publication bias. (A) Intraoperative blood loss, (B) postoperative blood loss, (C) total blood loss, (D) transfusion volume.

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