Intraoperative intravenous application of tranexamic acid reduces perioperative bleeding in multilevel posterior spinal surgery: A meta-analysis
10.3969/j.issn.2095-4344.4006
- Author:
Fangbiao ZHAN
1
Author Information
1. Department of Orthopedics, Three Gorges Hospital Affiliated to Chongqing University (Chongqing Three Gorges Central Hospital)
- Publication Type:Journal Article
- Keywords:
Bleeding;
Bone;
Meta-analysis;
Multilevel;
Posterior;
Randomized controlled trial;
Spinal surgery;
Tranexamic acid
- From:
Chinese Journal of Tissue Engineering Research
2020;25(6):977-984
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE: Tranexamic acid as a synthetic antifibrinolytic agent has been used in hip replacement, gastrointestinal surgery, neurosurgery, obstetrics and gynecology, cardiac surgery, and various nasal operations to reduce bleeding. In recent years, tranexamic acid has also been used in spinal surgery. Meta-analysis was used to evaluate whether intraoperative intravenous tranexamic acid reduced the incidence of perioperative bleeding and transfusion events in multilevel posterior spinal surgery compared with placebo. METHODS: The randomized controlled trials of tranexamic acid in the use of PubMed, Cochrane Library and EMBASE in multi-segment posterior spinal surgery were searched by computer. Tranexamic acid was used intravenously in the experimental group and placebo was used in the control group. Two reviewers screened all the retrieved literature according to the inclusion and exclusion criteria. The literature quality was evaluated with the modified Jadad scale and meta-analysis was performed with the Review Manager 5.3 software. RESULTS: (1) A total of nine randomized controlled trials were included in this study. The score of the modified Jadad scale showed 7 points in 6 articles, 6 points in 1 article, 4 points in 1 article and 3 points in 1 article. (2) Meta-analysis showed that the amount of postoperative drainage, intraoperative blood loss, intraoperative erythrocyte recovery, incidence of transfusion events, and total perioperative blood loss in the tranexamic acid group were all lower than those in the placebo group [MD=-102.70, 95%CI(-141.25,-64.15), Z=5.22, P<0.000 01; MD=-23.23, 95%CI(-44.00,-2.47), Z=2.19, P=0.03; MD=-139.36, 95%CI(-275.23,-3.49), Z=2.01, P=0.04; OR=0.52, 95%CI(0.33, 0.84), Z=2.71, P=0.007; MD=-228.98, 95%CI[-399.75,-58.22], Z=2.63, P=0.009]. Preoperative hemoglobin, hematocrit, immediate postoperative hemoglobin, hospital stay, and operation time had no significant difference between the two groups (P > 0.05). CONCLUSION: Intravenous tranexamic acid can reduce the total perioperative blood loss, intraoperative blood loss, postoperative drainage, intraoperative erythrocyte recovery and the incidence of transfusion events in posterior spinal multilevel surgery. However, due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality large-sample studies.
