Shim Sung Ryul, Han Sangah, Jeong Ji Hun, Hwang Inhwan, Cha Yonghan, Ihm Chunhwa
Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea.
Konyang Medical Data Research Group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea.
Front Surg. 2025 Apr 11;12:1550854. doi: 10.3389/fsurg.2025.1550854. eCollection 2025.
Severe blood loss during spine surgery increases the need for blood transfusion. Transfusion carries the risks of infection, complications, and postoperative morbidity; therefore, minimizing these risks is crucial for all surgical patients.
A comprehensive literature search was conducted in PubMed, Cochrane, and EMBASE to find studies examining the effect of tranexamic acid (TXA) on spine surgeries in patients who received blood transfusion. We used the mean difference (MD) and 95% credible intervals (CrI) to analyze continuous outcomes, such as intraoperative blood loss, postoperative blood loss, hemoglobin drop, and length of hospital stay. To evaluate categorical outcomes, such as blood transfusion rate and complication rate, the odds ratios (OR) and 95% CrI were determined.
A total of 38 randomized controlled trials were included, evaluating six outcomes across 10 treatment groups. Low-dose intravenous (IV) TXA combined with temperature intervention (15 mg/kg) significantly reduced intraoperative blood loss compared with placebo [MD: -112.0; 95% CrI: -211.0 to -14.9, surface under the cumulative ranking curve (SUCRA): 78.37%]. The administration of more than two doses of TXA significantly reduced intraoperative blood loss (MD: -101.0, 95% CrI: -161.0 to -44.1, SUCRA: 77.65%) and postoperative blood loss (MD: -177.0, 95% CrI: -275.0 to -92.4, SUCRA: 85.66%) compared with placebo. Both treatments significantly impacted the hemoglobin drop and blood transfusion rate.
Low-dose IV TXA with temperature intervention and the combined use of TXA significantly improved blood loss, hemoglobin drop, and blood transfusion rate during spine surgeries. Further studies involving larger populations are warranted and should be carefully designed to determine the potential risk of complications.
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024531557, identifier: CRD42024531557.
脊柱手术期间严重失血会增加输血需求。输血存在感染、并发症及术后发病的风险；因此，将这些风险降至最低对所有手术患者都至关重要。
在PubMed、Cochrane和EMBASE中进行了全面的文献检索，以查找研究氨甲环酸（TXA）对接受输血的脊柱手术患者影响的研究。我们使用平均差（MD）和95%可信区间（CrI）来分析连续结局，如术中失血、术后失血、血红蛋白下降和住院时间。为评估分类结局，如输血率和并发症发生率，确定了比值比（OR）和95% CrI。
共纳入38项随机对照试验，评估了10个治疗组的6项结局。与安慰剂相比，低剂量静脉注射（IV）TXA联合温度干预（15 mg/kg）显著减少术中失血[MD：-112.0；95% CrI：-211.0至-14.9，累积排名曲线下面积（SUCRA）：78.37%]。与安慰剂相比，给予超过两剂TXA显著减少术中失血（MD：-101.0，95% CrI：-161.0至-44.1，SUCRA：77.65%）和术后失血（MD：-177.0，95% CrI：-275.0至-92.4，SUCRA：85.66%）。两种治疗均对血红蛋白下降和输血率有显著影响。
低剂量IV TXA联合温度干预以及TXA的联合使用显著改善了脊柱手术期间的失血、血红蛋白下降和输血率。有必要开展涉及更多人群的进一步研究，并应精心设计以确定并发症的潜在风险。
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024531557，标识符：CRD42024531557。
