Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis

Shangyi Hui, Yue Peng, Liyuan Tao, Shengru Wang, Yang Yang, You Du, Jianguo Zhang, Qianyu Zhuang, TARGETS study group, Shangyi Hui, Yue Peng, Liyuan Tao, Shengru Wang, Yang Yang, You Du, Jianguo Zhang, Qianyu Zhuang, TARGETS study group

Abstract

Background: Although intravenous tranexamic acid administration (ivTXA) has prevailed in clinical antifibrinolytic treatment, whether it increases thromboembolic risks has remained controversial. As a potent alternative to ivTXA, topical use of TXA (tTXA) has been successfully applied to attenuate blood loss in various surgical fields while minimizing systemic exposure to TXA. This meta-analysis was conducted to gather scientific evidence for tTXA efficacy on reducing postoperative drainage, blood loss, and the length of hospital stay in spine surgeries.

Objectives: To examine whether topical use of TXA (tTXA) reduces postoperative drainage output and duration, hidden blood loss, hemoglobin level drop, hospital stay, and adverse event rate, we reviewed both randomized and non-randomized controlled trials that assessed the aforementioned efficacies of tTXA compared with placebo in patients undergoing cervical, thoracic, or lumbar spinal surgeries.

Methods: An exhaustive literature search was conducted in MEDLINE and EMBASE databases from January 2000 through March 2020. Measurable outcomes were pooled using Review Manager (RevMan) version 5.0 in a meta-analysis.

Results: Significantly reduced postoperative drainage output (weighted mean difference [WMD]= - 160.62 ml, 95% confidence interval (95% CI) [- 203.41, - 117.83]; p < .00001) and duration (WMD= - 0.75 days, 95% CI [- 1.09, - 0.40]; p < .0001), perioperative hidden blood loss (WMD= - 91.18ml, 95% CI [- 121.42, - 60.94]; p < .00001), and length of hospital stay (WMD= - 1.32 days, 95% CI [- 1.90, - 0.74]; p < .00001) were observed in tTXA group. Pooled effect for Hb level drop with tTXA vs placebo crossed the equivalent line by a mere 0.05 g/dL, with the predominant distribution of 95% confidence interval (CI) favoring tTXA use.

Conclusions: With the most comprehensive literature inclusion up to the present, this meta-analysis suggests that tTXA use in spinal surgeries significantly reduces postoperative drainage, hidden blood loss, and hospital stay duration. The pooled effect also suggests that tTXA appears more effective than placebo in preserving postoperative Hb level, which needs further validation by future studies.

Keywords: Blood loss; Hospital stay; Postoperative drainage; Spinal surgery; Topical tranexamic acid.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow chart. Study selection process in this meta-analysis
Fig. 2
Fig. 2
Funnel plot of postoperative drainage output. Funnel plot of tTXA use was compared with placebo on the postoperative drainage output. tTXA, topical use of tranexamic acid
Fig. 3
Fig. 3
Risk of bias summary: review authors’ judgments about each risk of bias item for each included study
Fig. 4
Fig. 4
Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies
Fig. 5
Fig. 5
Forest plot of postoperative drainage output. CI, confidence interval; IV, inverse variance methods; tTXA, topical use of tranexamic acid; Random, random-effects modeling
Fig. 6
Fig. 6
Forest plot of postoperative drainage duration. CI, confidence interval; IV, inverse variance methods; tTXA, topical use of tranexamic acid; Random, random-effects modeling
Fig. 7
Fig. 7
Forest plot of perioperative hidden blood loss. CI, confidence interval; IV, inverse variance methods; tTXA, topical use of tranexamic acid; Fixed, fixed-effects modeling
Fig. 8
Fig. 8
Forest plot of postoperative hemoglobin (Hb) level drop. CI, confidence interval; IV, inverse variance methods; tTXA, topical use of tranexamic acid; Random, random-effects modeling
Fig. 9
Fig. 9
Forest plot of length of hospital stay (LOH). CI, confidence interval; IV, inverse variance methods; tTXA, topical use of tranexamic acid; Random, random-effects modeling
Fig. 10
Fig. 10
Forest plot of adverse event rate. CI, confidence interval; M-H, Mantel-Haenszel; tTXA, topical use of tranexamic acid; Fixed, fixed-effects modeling

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