Article Figures & Data
Figures
- Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
- Figure 2
Risk of bias table generated using the RoB-2 tool.
- Figure 3
Funnel plot of intraoperative blood loss demonstrating publication bias. SE, standard error; SMD, standard mean difference.
- Figure 4
Forest plot showing the effect of tranexamic acid on total blood loss.
- Figure 5
(A) Forest plot showing the effect of tranexamic acid (TXA) on intraoperative blood loss. (B) Forest plot showing the effect of TXA on intraoperative blood loss after leave-one-out analysis and exclusion of Weera 2018.
- Figure 6
Forest plot showing effect of tranexamic acid on postoperative blood loss.
- Figure 7
Forest plot showing effect of tranexamic acid on hidden blood loss.
- Figure 8
Forest plot showing effect of tranexamic acid on perioperative hemoglobin levels.
- Figure 9
(A) Forest plot showing effect of topical tranexamic acid (tTXA) on operative duration. (B) Forest plot showing effect of tTXA on operative duration after leave-one-out analysis and exclusion Jieliang 2020.
- Figure 10
(A) Forest plot showing effect of intravenous tranexamic acid (iTXA) on operative duration. (B) Forest plot showing effect of iTXA on operative duration after leave-one-out analysis and exclusion of Wentao 2018.
- Figure 11
Forest plot showing effect of tranexamic acid on blood transfusions.
- Figure 12
Forest plot showing effect of tranexamic acid on length of hospital stay.
- Figure 13
Forest plot showing effect of tranexamic acid on incidence of deep vein thrombosis.
- Figure 14
Forest plot showing effect of tranexamic acid on incidence of pulmonary embolism.
Tables
Study Country Study Type Surgical Method Groups Age, y, Mean ± SD Gender M:F TXA Dosing Inclusion Criteria Exclusion Criteria Outcome Measures Garg 201224 India Prospective, randomized Open posterior instrumentation Intervention, Control Not mentioned Not mentioned 15 mg/kg bolus IV, 15 min before incision Not mentioned Not mentioned IBL, PBL, numberof blood transfusions, DVT incidence, and D-D Hamdi 201625 Tunisia Prospective, randomized Not mentioned Intervention, Control 48.4 ± 16.2, 54.4 ± 13.7 17:8, 15:10 10 mg/kg bolus IV, 1 mg/kg/h IV intra-and postoperatively Not mentioned Not mentioned IBL, PBL, numberof blood transfusions, DVT incidence, and D-D Weera 201926 Thailand Prospective, randomized Open long-segment PSF without decompression Intervention, Control 52 (33.5, 55.5), 51.5 (33.5, 58) 20:9, 15:13 1 g in 20 mL saline topical application via drain, clamped for 2 h Adults with thoracolumbar fractures undergoing posterior fixation surgery, no neurological deficits, ASA I, II, III History of thromboembolic/cardiac disease, coagulation disorder displaced laminar fractures Transfusion rates, PBL, drain removal time, duration of hospitalization Xiji 201927 China Prospective, randomized, single blinded Percutaneous pedicle screw fixation Intervention A, Intervention B, Intervention C 45.43 ± 8.18, 45.72 ± 9.96, 45.47 ± 11.24 34:27, 37:24, 33:26 Group A: 15 mg/kg bolus IV, 30 min before incision, Group B: topical 3 g insaline before wound closure, Group C: combined IV+ topical as above Adults with single-level thoracolumbar fractures withno neurological deficits undergoingsurgery within 2wk of injury History of DVT, intake of antiplatelet/anticoagulant medications, multiple injuries Pre- and postoperative: Hct, D-D; DVT inlower limbs, transfusionrate, complications, operative duration,IBL, TBL, HBL Wentao 201928 China Prospective, randomized, double blinded Open PSF with transforaminal interbody fusion Intervention, Control 41.2 ± 10.3, 42.5 ± 9.5 25:18, 18:19 10 mg/kg bolus IV, 15 min before incision, 1 mg/kg/h infusion during surgery Adult patients with fracture dislocation at the thoracolumbar junction undergoing surgery within 24 h for 2-level involvement Involved segments above T11 or below L2, on anticoagulation, any contraindication to TXA use, severeinjuries, CSF leakage Operative duration, TBL, IBL, Hb, transfusionrate, DVT incidence, levels of pre- andpostoperative GMP 140, FIB, FDP, and D-D Feng 202029 China Retrospective cohort PSF using Wiltse approach Intervention A, Intervention B, Control 42.14 ± 9.86, 40.34 ± 10.28, 41.06 ± 10.26 60:24, 57:30, 63:30 Group A: 20 mg/kg TXA at 5 min before skin incision and 16 h after first dose; Group B received 20 mg/kg TXAat 5 min before skin incision Adults with single segment fractures without neurological deficits who underwent surgery using the Wiltse approach and other conservatively managed fractures Pelvic and femoral fractures, cardiac/CNS disease, intake of medication that alter hemostasis Pre- and postoperative: Hb, FDP, D-D, FIB, Hct, LFT, PT-INR, APTT, CRP, IL-6; DVT in lower limbs, transfusion rate, complications operative duration, IBL, TBL, HBL Pradhan 201530 Nepal Prospective, observational Open PSF Intervention, Control 39.47 ± 13.52, 32.19 ± 10.71 Notmentioned 10 mg/kg bolus IV, 30 min before incision and 3 h postoperatively + oral medication Adults undergoing single-level PSF 2-Level surgeries, fracture level screw fixation, iliac crest graft Pre- and postoperative Hb, PT-INR, transfusion rates, operative duration, IBL, PBL, complications Jieliang 202031 China Prospective, randomized, double blinded Open PSF Intervention, Control 38.85 ± 4.17, 39.41 ± 6.51 25:14, 22:15 1 g in 100 mL saline topical application in the wound postmuscle dissection, kept for 5 min Adults with single-level thoracolumbar fractures with/without neurological deficits undergoing surgery within 24 hof injury without osteoporosis Multiple comorbidities, multiple fractures, coagulopathies, CSF leakage, pathological fractures TBL, HBL, IBL, PBL, HB, Hct, transfusion rate, length of hospital stay, operative duration Abdel 202032 Egypt Prospective, randomized, double blinded Open PSF Intervention, Control 52 (33.5, 55.5), 51.5 (33.5, 58) 7:8, 4:11 1 g in 50 mL saline topical application via drain, clamped for 2 h Adults with thoracolumbar fractures without neurological deficits Renal insufficiency, history of thromboembolism, history of cardiovascular diseases, coagulopathies, allergy to TXA, history of aspirin or NSAID intake 1 wk before randomization Pre- and postoperativeHb, PBL Lehman et al34 United States Prospective, randomized, double blinded 3 g TXA in 70 mL saline topical solution left in wound for 5 min vs saline placebo Adult thoracolumbar spine trauma with/without deficits undergoing surgery within 21 d; adult patients undergoing long-segment fusions (>5 fusion levels) Coagulopathies or history of thromboembolic events; therapeutic anticoagulation requirement; use of intravenous TXA during prestudy period; trauma penetrating spinal cord or dural tears; history of seizure; traumatic brain injury Primary outcome: maximal postoperative Hb drop, secondry outcomes: Health related quality of life, complications, cost analysis, surgical site infection, systemic absorption Sheng et al33 China Randomized controlled trial, single blinded Group 1: intravenous TXA 10 mg/kg before incision; Group 2 topical TXA 10 mg/kg wash before wound closure; Group 3: saline placebo Adult thoracolumbar spine trauma with no coagulopathy undergoing surgery within 2 wk Low Hb or platelet counts or preoperative coagulopathy; has received antiplatelet/coagulant therapy; hypercoagulable states or history of thromboembolism Primary outcome: IBL; secondary outcome: blood transfusion, PBL, Hb, PT-INR, D-D. and APTT APTT, activated prothrombin time; CSF, cerebrospinal fluid; D-D, D-dimer; DVT, deep vein thrombosis; FDP, fibrinogrn degeneration products; FIB, fibrinogen intermediate products; Hb, hemoglobin; HBL, hidden blood loss; Hct, hematocrit; IBL, intraoperative blood loss; IV, intravenous; NSAID, non-steroidal anti-inflammatory drugs; PBL, postoperative blood loss; PE, pulmonary embolism; PSF, pedicle screw fixation; PT-INR, prothrombin time-international normalized ratio; TBL, total blood loss; TXA, tranexamic acid.
MINORS Criteria Pradhan 2015 Feng 2020 1 Clearly stated aim 2 2 2 Inclusion of consecutive patients 0 0 3 Prospective collection of data 2 0 4 Endpoints appropriate to aim of study 2 2 5 Unbiased assessment of the study endpoint 0 2 6 Follow-up period appropriate to the aim of the study 1 1 7 Loss to follow-up less than 5% 0 0 8 Prospective calculation of study size 0 0 9 An adequate control group 2 2 10 Contemporary groups 2 2 11 Baseline equivelance of groups 2 2 12 Adequate statistical analysis 1 2 Total 14 15 Note: The items are scored 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). The global ideal score is 16 for non-comparative studies and 24 for comparative studies
MINORS, methodological index for nonrandomized studies.
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