Comparing the efficacy and safety of oral versus intravenous tranexamic acid in spine surgery: a systematic review and meta-analysis of randomized controlled trials.

Spine surgery is associated with significant blood loss, increasing the risk of complications, transfusions, delayed recovery, and longer hospital stays. Tranexamic Acid (TXA) is widely used to reduce bleeding, but it remains unclear whether oral or intravenous TXA is more effective in spine surgery. We conduct a systematic review of randomized controlled trials (RCTs) comparing oral and intravenous TXA in spine surgery. The primary outcomes are perioperative blood loss, transfusion rates, and postoperative complications. Data are extract independently by two reviewers and analyzed using Review Manager 5.4, with results expressed as mean difference (MD) or odds ratio (OR). Four RCTs are included. Both oral and intravenous TXA show similar effects in reducing intraoperative blood loss, total blood loss, Hct, Hgb and transfusion rates. Oral TXA is superior in reduce postoperative drainage volume (MD = -16.36, P = 0.004). No significant differences are observed in DVT, infection rates, or hospital stay. Both oral and intravenous TXA are effective in reducing blood loss and transfusion needs, with similar safety profiles. While oral TXA showed statistically significant reduction in postoperative drainage, this difference may have limited clinical significance. Given its comparable effectiveness, potentially lower cost, and easier administration, oral TXA represents a viable alternative to intravenous TXA in spine surgery. Further studies are needed to determine the optimal TXA administration route for spine surgery.