1Department of Neurological Surgery, University of California, Irvine, Orange, California.
2Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Neurosurg Spine. 2021 Nov 5;36(4):686-693. doi: 10.3171/2021.7.SPINE202217. Print 2022 Apr 1.
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.
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.
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.
TXA can significantly reduce perioperative blood loss in cervical, thoracic, and lumbar laminectomy and fusion procedures, while demonstrating a minimal complication profile.
氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，可减少广泛手术中的失血量和死亡率，包括脊柱手术、创伤性脑损伤和颅缝早闭。尽管如此广泛的应用，TXA 在脊柱手术中的安全性和有效性一直被认为是有争议的，因为相关文献相对较少，报告的研究中缺乏统计学效力。然而，如果 TXA 能证明在融合后路内固定椎板切除术和融合后路内固定术中减少失血，更多的外科医生可能会将其纳入他们的手术工具中。作者旨在对 TXA 在减少后路椎板切除融合和后路内固定术中失血的有效性进行最新的系统评价和荟萃分析。
通过检索 PubMed、Web of Science 和 Cochrane 数据库，按照 PRISMA 指南进行系统评价和荟萃分析。这些平台对所有报告 TXA 在椎板切除融合和后路内固定术中应用的研究进行了检索。检索的变量包括患者人口统计学、手术适应证、涉及的脊柱水平、进行的椎板切除术类型、TXA 给药剂量、TXA 给药途径、手术时间、失血量、输血率、术后血红蛋白水平和围手术期并发症。使用 R 统计编程软件进行卡方检验、Cochran's Q 检验和 I2 检验来评估研究之间的异质性。
共有 7 篇文章纳入定性研究，6 篇文章纳入 411 例患者进行统计学分析。TXA 最常见的给药途径是静脉内给予 15mg/kg，术前给予。手术开始后，TXA 的给药模式在研究之间有所不同。与 TXA 组相比，非 TXA 组的输血增加。接受 TXA 的患者失血量显著减少（平均差异-218.44ml；95%CI-379.34 至-57.53；p=0.018）。TXA 给药与手术时间的显著缩短无关。在 TXA 或非 TXA 患者组均未报告不良事件。
TXA 可显著减少颈椎、胸椎和腰椎椎板切除和融合手术中的围手术期失血，同时显示出最小的并发症特征。
