Affordable Excellence: A Meta-Analysis on the Efficacy of Topical Tranexamic Acid in Reducing Blood Loss in Thoracolumbar Spinal Surgery.

AIM: To evaluate the efficacy and safety of topical tranexamic acid (tTXA) in thoracolumbar fusion surgery.

MATERIAL AND

METHODS

A systematic review was conducted per PRISMA guidelines. Studies from January 1970 to August 2024 were retrieved from PubMed, Cochrane, EMBASE, Medline, and Google Scholar. Randomized controlled trials, non-RCTs, and cohort studies comparing tTXA with placebo or standard care in thoracolumbar surgery were included.

RESULTS

Eleven studies with 986 patients met the criteria. tTXA significantly reduced intraoperative blood loss (MD: -25.85 mL, p = 0.002), postoperative drain output (MD: -84.82 mL, p < 0.00001), transfusion rates (OR: 0.33, p = 0.0004), and hospital stay (MD: -0.67 days, p < 0.00001). It also increased postoperative hemoglobin (MD: 0.39 g/dL, p < 0.00001) but slightly prolonged operative time (MD: 3.73 minutes, p < 0.00001). No significant difference was found in complication rates (p = 0.36).

CONCLUSION

tTXA is effective in reducing blood loss and transfusion needs in thoracolumbar surgery, with minimal risk. Slightly increased operative time is clinically acceptable.