Yerneni Ketan, Burke John F, Tuchman Alexander, Li Xudong J, Metz Lionel N, Lehman Ronald A, Lenke Lawrence G, Tan Lee A
Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, United States.
Department of Neurological Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States.
J Clin Neurosci. 2019 Mar;61:114-119. doi: 10.1016/j.jocn.2018.10.121. Epub 2018 Nov 3.
Tranexamic acid (TXA) is a commonly used antifibrinolytic agent for perioperative blood conservation in several surgical specialties. Although historically administered intravenously, such systemic administration may be accompanied by severe side effects. Thus, the topical usage of TXA has been established in several fields but remains poorly evaluated in spine surgery. In this study, the authors aimed to review the medical literature on topical TXA usage in spine surgery to evaluate its safety and efficacy. We reviewed manuscripts and clinical trials exploring topical TXA usage in spine surgery published by April 1st, 2018. Postoperative blood loss volumes and hospitalization lengths of stay were evaluated with separate meta-analyses. We identified five articles and one unpublished clinical trial that were placebo-controlled and comprised 218 patients receiving topical TXA in spine surgery. Patients receiving topical TXA demonstrated significantly lower postoperative blood loss as compared to the placebo group (Standardized Mean Difference [SMD] 2.21, 95% CI 0.79-3.62, p < 0.001) and had a lower hospitalization duration (MD 0.99, 95% CI 0.49-1.49, p < 0.001). Overall, topical TXA favorably reduced postoperative blood loss and hospitalization duration in patients undergoing spinal surgery. However, further randomized controlled trials will be needed to definitively establish the optimal therapeutic doses needed for hemorrhage management, and the pharmacodynamics of tTXA in spinal surgery.
氨甲环酸（TXA）是一种常用的抗纤溶药物，用于多个外科专业的围手术期血液保护。尽管历史上一直通过静脉给药，但这种全身给药可能会伴有严重的副作用。因此，TXA的局部应用已在多个领域得到确立，但在脊柱手术中的评估仍很少。在本研究中，作者旨在回顾脊柱手术中局部应用TXA的医学文献，以评估其安全性和有效性。我们回顾了截至2018年4月1日发表的探索脊柱手术中局部应用TXA的手稿和临床试验。通过单独的荟萃分析评估术后失血量和住院时间。我们确定了五篇文章和一项未发表的临床试验，这些研究均为安慰剂对照，共纳入218例在脊柱手术中接受局部TXA治疗的患者。与安慰剂组相比，接受局部TXA治疗的患者术后失血量显著更低（标准化均数差[SMD] 2.21，95%可信区间0.79 - 3.62，p < 0.001），住院时间也更短（MD 0.99，95%可信区间0.49 - 1.49，p < 0.001）。总体而言，局部应用TXA有利于减少脊柱手术患者的术后失血量和住院时间。然而，需要进一步的随机对照试验来明确确定出血管理所需的最佳治疗剂量，以及局部应用TXA在脊柱手术中的药效学。
