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

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.