Effectiveness of intravenous Tranexamic Acid (TXA) administration in managing perioperative blood loss in patients undergoing spine surgery: a systematic review protocol

Abstract Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

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Association of tranexamic acid with decreased blood loss in patients undergoing laminectomy and fusion with posterior instrumentation: a systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2021.7.spine202217 ◽

2021 ◽

pp. 1-8

Author(s):

Nolan J. Brown ◽

Elliot H. Choi ◽

Julian L. Gendreau ◽

Vera Ong ◽

Alexander Himstead ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Posterior Instrumentation ◽

Meta Analysis ◽

Route Of Administration ◽

Transfusion Rate ◽

Wide Range ◽

Laminectomy And Fusion

OBJECTIVE Tranexamic acid (TXA) is an antifibrinolytic agent associated with reduced blood loss and mortality in a wide range of procedures, including spine surgery, traumatic brain injury, and craniosynostosis. Despite this wide use, the safety and efficacy of TXA in spine surgery has been considered controversial due to a relative scarcity of literature and lack of statistical power in reported studies. However, if TXA can be shown to reduce blood loss in laminectomy with fusion and posterior instrumentation, more surgeons may include it in their armamentarium. The authors aimed to conduct an up-to-date systematic review and meta-analysis of the efficacy of TXA in reducing blood loss in laminectomy and fusion with posterior instrumentation. METHODS A systematic review and meta-analysis, abiding by PRISMA guidelines, was performed by searching the databases of PubMed, Web of Science, and Cochrane. These platforms were queried for all studies reporting the use of TXA in laminectomy and fusion with posterior instrumentation. Variables retrieved included patient demographics, surgical indications, involved spinal levels, type of laminectomy performed, TXA administration dose, TXA route of administration, operative duration, blood loss, blood transfusion rate, postoperative hemoglobin level, and perioperative complications. Heterogeneity across studies was evaluated using a chi-square test, Cochran’s Q test, and I2 test performed with R statistical programming software. RESULTS A total of 7 articles were included in the qualitative study, while 6 articles featuring 411 patients underwent statistical analysis. The most common route of administration for TXA was intravenous with 15 mg/kg administered preoperatively. After the beginning of surgery, TXA administration patterns were varied among studies. Blood transfusions were increased in non-TXA cohorts compared to TXA cohorts. Patients administered TXA demonstrated a significant reduction in blood loss (mean difference −218.44 mL; 95% CI −379.34 to −57.53; p = 0.018). TXA administration was not associated with statistically significant reductions in operative durations. There were no adverse events reported in either the TXA or non-TXA patient cohorts. CONCLUSIONS TXA can significantly reduce perioperative blood loss in cervical, thoracic, and lumbar laminectomy and fusion procedures, while demonstrating a minimal complication profile.

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Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: a systematic review and network meta-analysis

North American Spine Society Journal (NASSJ) ◽

10.1016/j.xnsj.2021.100086 ◽

2021 ◽

pp. 100086

Author(s):

Roman Rahmani ◽

Amy Singleton ◽

Zachary Fulton ◽

John M. Pederson ◽

Thomas Andreshak

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Meta Analysis ◽

Loss Reduction ◽

Dosing Strategies ◽

Blood Loss Reduction

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Safety and efficacy of tranexamic acid in bleeding paediatric trauma patients: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2016-012947 ◽

2016 ◽

Vol 6 (9) ◽

pp. e012947 ◽

Cited By ~ 8

Author(s):

Denisa Urban ◽

Ruben Dehaeck ◽

Diane Lorenzetti ◽

Jonathan Guilfoyle ◽

Man-Chiu Poon ◽

...

Keyword(s):

Systematic Review ◽

Tranexamic Acid ◽

Trauma Patients ◽

Systematic Review Protocol ◽

Safety And Efficacy ◽

Paediatric Trauma ◽

Review Protocol

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EFFECT OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING THORACOLUMBAR SPINE SURGERY

10.36106/gjra/1705708 ◽

2021 ◽

pp. 32-34

Author(s):

Santhi KS ◽

Smrithi JP ◽

Susan T Cheeran

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Normal Saline ◽

Thoracolumbar Spine ◽

Hemodynamic Instability ◽

Blood Transfusions ◽

Perioperative Blood Loss ◽

Transfusion Requirements

BACKGROUND: Spine surgeries are usually associated with excessive blood loss, which increases morbidity and mortality due to hemodynamic instability and subsequent blood transfusions. Tranexamic acid (TXA), an antibrinolytic drug, inhibits the activation of plasminogen, is found to be useful in reducing blood loss. METHODOLOGY: A prospective observational study conducted in Government Medical College, Kottayam for a period of twelve months, randomly assigned forty-eight adult patients (ASA I or II) undergoing thoracolumbar spine surgery into two groups, who received either a bolus of 10 mg/kg IV TXA after induction followed by an infusion of 1 mg/kg/h of TXA up to closure of skin, or an equivalent volume of normal saline. Blood investigations, surgical parameters, perioperative blood loss and blood transfusions were assessed. RESULTS: Both groups in the study were comparable with respect to demographic variables, baseline laboratory indices and surgical parameters. The mean perioperative blood loss was 44% less (P<0.05) and blood transfusion requirements were 71% reduced (P<0.05) in patients who received TXA. Mean surgical duration as well as postoperative hemoglobin drop was signicantly reduced in TXA group compared to Normal Saline group (NS). CONCLUSION: Tranexamic acid reduces perioperative blood loss and blood transfusion.

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Sleep and cognition in schizophrenia spectrum disorders: A systematic review protocol.

10.31234/osf.io/cbxud ◽

2020 ◽

Author(s):

Sean Carruthers ◽

Gemma Brunetti ◽

Susan Rossell

Keyword(s):

Systematic Review ◽

Mental Illnesses ◽

Schizophrenia Spectrum Disorders ◽

Systematic Review Protocol ◽

Schizophrenia Spectrum Disorder ◽

Schizophrenia Spectrum ◽

Review Protocol ◽

Spectrum Disorders ◽

Sleep And Cognition ◽

The Relationship

Schizophrenia spectrum disorders are chronic and debilitating mental illnesses characterised by both cognitive impairments and sleep deficits. In this systematic review protocol, we outline an approach to examine the available literature investigating the relationship between sleep and cognition in individuals with schizophrenia spectrum disorder.

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Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine1814 ◽

2019 ◽

Vol 31 (2) ◽

pp. 194-200 ◽

Cited By ~ 1

Author(s):

Signe Elmose ◽

Mikkel Ø. Andersen ◽

Else Bay Andresen ◽

Leah Yacat Carreon

Keyword(s):

Placebo Group ◽

Lumbar Spine ◽

Blood Loss ◽

Tranexamic Acid ◽

Spine Surgery ◽

Operative Time ◽

Decompressive Surgery ◽

Lumbar Spine Surgery ◽

Intraoperative Blood Loss ◽

Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

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