title: Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis.
abstract: BACKGROUND
  Spine surgery is usually associated with large amount of blood loss, necessitating blood transfusions. Blood loss-associated morbidity can be because of direct risks, such as hypotension and organ damage, or as a result of blood transfusions. The antifibrinolytic, tranexamic acid (TXA), is a lysine analog that inhibits activation of plasminogen and has shown to be beneficial in reducing surgical blood loss.
  
  
  OBJECTIVE
  To consolidate the findings of randomized controlled trials (RCTs) investigating the use of TXA on surgical bleeding in spine surgery.
  
  
  METHODS
  A metaanalysis.
  
  
  METHODS
  Randomized controlled trials investigating the effectiveness of intravenous TXA in reducing blood loss in spine surgery, compared with a placebo/no treatment group.
  
  
  METHODS
  MEDLINE, Embase, Cochrane controlled trials register, and Google Scholar were used to identify RCTs published before January 2014 that examined the effectiveness of intravenous TXA on reduction of blood loss and blood transfusions, compared with a placebo/no treatment group in spine surgery. Metaanalysis was performed using RevMan 5. Weighted mean difference with 95% confidence intervals was used to summarize the findings across the trials for continuous outcomes. Dichotomous data were expressed as risk ratios with 95% confidence intervals. A p<.05 was considered statistically significant.
  
  
  RESULTS
  Eleven RCTs were included for TXA (644 total patients). Tranexamic acid reduced intraoperative, postoperative, and total blood loss by an average of 219 mL ([-322, -116], p<.05), 119 mL ([-141, -98], p<.05), and 202 mL ([-299, -105], p<.05), respectively. Tranexamic acid led to a reduction in proportion of patients who received a blood transfusion (risk ratio 0.67 [0.54, 0.83], p<.05) relative to placebo. There was one myocardial infarction (MI) in the TXA group and one deep vein thrombosis (DVT) in placebo.
  
  
  CONCLUSIONS
  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, DVT, or MI.
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA. Electronic address: thomascheriyan@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cheriyan
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Maier
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bianco
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Kseniya
authors.initials: K
authors.lastname: Slobodyanyuk
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Rattenni
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York Langone Medical Center, 306 East, 15th St, New York, NY 10003, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D013131:Spine / Q000601:surgery*; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Adult spine deformity; Antifibrinolytics; Blood loss; Epsilon-aminocaproic acid; Spine surgery; Tranexamic acid; Transfusion rate