Tranexamic acid reduces surgical bleeding in spine surgery without increased risks

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A meta-analysis published online by The Spine Journal  demonstrates that the use of  the antifibrinolytic, tranexamic acid in spinal surgery results in less blood loss without an increased risks of complications such as  pulmonary embolism, deep vein thrombosis or myocardial infraction.

Lead author Thomas Cheriyan, Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, USA, and colleagues write that “Spine surgery is usually associated with large blood loss necessitating blood transfusions. Blood loss-associated morbidity can be due to direct risks, such as hypotension and organ damage, or as result of blood transfusions.”

The purpose of the meta-analysis was to consolidate the findings of randomised controlled trials investigating the use of an antifibrinolytic, tranexamic acid, on surgical bleeding in spine surgery. A lysine analogue, tranexamic acid inhibits activation of plasminogen and has been shown to be beneficial in reducing surgical blood loss.

The study team used MEDLINE, Embase, Cochrane controlled trials register and Google Scholar to identify randomised controlled trials published before January 2014 that examined the effectiveness of intravenous tranexamic acid on reduction of blood loss and blood transfusions, compared to a placebo/no treatment group in spine surgery. Meta-analysis was performed using RevMan 5 software. Weighted mean difference was used to summarise findings across the trials for continuous outcomes with dichotomous data expressed as risk ratio with 95% confidence intervals. The authors considered a value of p

The study results drew from 11 trials of tranexamic acid (644 total patients). Tranexamic acid was found to reduce intraoperative and postoperative blood loss by an average of 219ml (p<0.05) and 119ml (p<0.05) respectively. The use of tranexamic acid also led to a reduction in the proportion of patients who received a blood transfusion (relative risk 0.67; p<0.05) relative to placebo. There was one myocardial infarction in the tranexamic acid group and one deep vein thrombosis in the placebo group.

Cheriyan and colleagues comment that “Tranexamic acid reduces surgical bleeding and transfusion requirements in patients undergoing spine surgery. Tranexamic acid does not appear to be associated with an increased incidence of pulmonary embolism, deep vein thrombosis or myocardial infection.”

Thomas Errico the principal investigator and chief, Division of Spine Surgery at New York University Langone Medical Center, opined, “Given the overwhelming evidence on the efficacy of tranexamic acid in reducing surgical bleeding, there is no doubt about its indication for use. Future research should be and is now directed toward identifying the appropriate dosing in both our pediatric and adult age groups.”