Xie Chengxin, Zhang Liwei, Cai Guoping, Su Yongwei, Wang Peng, Luo Hua
Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, China.
Department of Orthopedic, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121000, China.
BMC Surg. 2025 Jan 9;25(1):15. doi: 10.1186/s12893-024-02743-2.
The relative efficacies of topical and intravenous tranexamic acid (TXA) in spinal surgery remain controversial. This meta-analysis aimed to compare the efficacy and safety of topical versus intravenous TXA in spinal surgery, with a particular focus on the impacts on intraoperative blood loss (IBL) and associated outcomes.
We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature related to topical and intravenous TXA in spinal surgery. Six trials met the inclusion criteria. The IBL, postoperative drainage volume, total blood loss, postoperative hematological variables, postoperative blood transfusions, and complications were analyzed.
The meta-analysis of randomized controlled trials indicated that IBL and total blood loss were markedly higher in the group receiving topical TXA compared to the intravenous TXA group. Conversely, data from retrospective studies did not show significant differences between the two groups. Hemoglobin levels on postoperative days 1 and 3 were significantly lower in the topical TXA group than in the intravenous TXA group. No significant differences were observed between the topical and intravenous TXA groups regarding other postoperative hematological parameters, drainage volume, transfusion rates, and complications.
The current evidence suggests that topical TXA does not significantly reduce postoperative blood loss in spinal surgery compared with intravenous TXA, but has good safety and does not increase the associated risks. There is a need for high-quality studies that explore the effects of topical TXA in spinal surgery.
局部应用和静脉注射氨甲环酸（TXA）在脊柱手术中的相对疗效仍存在争议。本荟萃分析旨在比较局部应用与静脉注射TXA在脊柱手术中的疗效和安全性，特别关注对术中失血（IBL）及相关结果的影响。
我们检索了PubMed、EMBASE、Medline和Cochrane图书馆数据库，以识别所有与脊柱手术中局部应用和静脉注射TXA相关的文献。六项试验符合纳入标准。对IBL、术后引流量、总失血量、术后血液学指标、术后输血情况及并发症进行了分析。
随机对照试验的荟萃分析表明，与静脉注射TXA组相比，接受局部应用TXA组的IBL和总失血量明显更高。相反，回顾性研究的数据显示两组之间无显著差异。局部应用TXA组术后第1天和第3天的血红蛋白水平显著低于静脉注射TXA组。在其他术后血液学参数、引流量、输血率及并发症方面，局部应用和静脉注射TXA组之间未观察到显著差异。
目前的证据表明，与静脉注射TXA相比，局部应用TXA在脊柱手术中并不能显著减少术后失血，但安全性良好，且不会增加相关风险。需要高质量的研究来探索局部应用TXA在脊柱手术中的效果。
