Background: There is controversy regarding the efficacy of intravenous combined topical tranexamic acid. We conducted this study to systematically assess the effectiveness of intravenous combined topical tranexamic acid (combined TXA) in spinal surgery to guide clinical practice.
Methods: The review process was conducted according to the PRISMA guidelines. A systematic search of PubMed, EMBASE, Web of Science, and Cochrane Central was conducted for RCTs and comparative cohort studies evaluating the effect of combined TXA on blood loss in spinal surgery. Outcomes such as intraoperative blood loss, total blood loss, postoperative drainage, postoperative hemoglobin level on postoperative days 1 and 3, postoperative transfusion rates, and complications were analyzed.
Results: Five studies covering 528 patients were included in the analysis. Combined TXA, compared with intravenous TXA, showed no significant differences in intraoperative blood loss (P = 0.18 for RCTs, P = 0.50 for the retrospective study), total blood loss (P = 0.085 for RCTs, P = 0.87 for the retrospective study), postoperative drainage (P = 0.137 for RCTs, P = 0.232 for the retrospective study), postoperative hemoglobin (P = 0.737 on postoperative day 1, P = 0.403 on postoperative day 3), postoperative transfusion rates (P = 0.202), and complications (P = 0.493).
Conclusions: Based on the available evidences, our meta-analysis failed to demonstrate the apparent advantages of combined tranexamic acid in spinal surgery. Clinical decisions regarding hemostatic methods should continue to be individualized based on the patient's specific situation and the doctor's experience.
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| http://dx.doi.org/10.1186/s12891-024-08191-6 | DOI Listing |
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