Our experience in spinal surgery: a systematic review comparing the single and combined use of Tranexamic acid

Résumé

Objective Tranexamic acid (TXA) is a chemical compound that can control the amount of bleeding and is often used in spinal surgery. TXA can be used alone or in combination. The study compared the effects of the two administrations, single-use or combined-use, providing a basis for the optimal route of TXA application. Methods Intravenous injection of TXA or topical TXA was used in the experimental group, and combined TXA was used in the control group. A systematic literature search without language restrictions was conducted until November 10, 2023. Statistical analyses were performed using Revman 5.4. Results Four randomized controlled trials (RCTs) and one retrospective cohort study (RCS) were included, involving 682 patients. There were no significant differences in postoperative blood loss (PBL), preoperative haemoglobin (Hb), postoperative Hb, postoperative D-dimer level, operative time, nor complications between the two groups. However, there were statistically significant differences in intraoperative blood loss (IBL), total blood loss (TBL), and preoperative D-dimer levels between the two groups. (IBL: MD=48.63, 95%CI (confidence interval) =[12.61, 84.65], P=0.008, I 2=88%; TBL: MD=140.95, 95%CI= [25.97, 255.93], P=0.02, I 2=75%； Preoperative D-dimmer: MD=-0.15, 95%CI=[-0.19, -0.11], P<0.00001, I 2=0%). Conclusion During spinal surgery, single use of TXA was no better than combined use of TXA in terms of IBL, TBL, and preoperative D-dimer levels. However, the meta-analysis suggests that more high-quality studies need to be included to further compare the results between the two groups to make recommendations for the optimal use of TXA.

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