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Systemic and Topical Use of Tranexamic Acid in Spinal Surgery: A Systematic Review.

Winter SF, Santaguida C, Wong J, Fehlings MG - Global Spine J (2015)

Bottom Line: Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding.We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site.Use of topical TXA in surgery suggests similar hemostatic efficacy and potentially improved safety as compared with intravenous TXA.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, Charité University Medicine Berlin, Berlin, Germany.

ABSTRACT
Study Design Combination of narrative and systematic literature reviews. Objectives Massive perioperative blood loss in complex spinal surgery often requires blood transfusions and can negatively affect patient outcome. Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding. We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site. Through a systematic review of published and ongoing investigations on topical TXA for spinal surgery, we wish to make spine practitioners aware of this option and to suggest opportunities for further investigation in the field. Methods A narrative review of systemic TXA in spinal surgery and topical TXA in surgery was conducted. Furthermore, a systematic search (using PRISMA guidelines) of PubMed (MEDLINE), EMBASE, and Cochrane CENTRAL databases as well as World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov (National Institutes of Health), and International Standard Randomized Controlled Trial Number registries was conducted to identify both published literature and ongoing clinical trials on topical TXA in spinal surgery. Results Of 1,631 preliminary search results, 2 published studies were included in the systematic review. Out of 285 ongoing clinical trials matching the search criteria, a total of 4 relevant studies were included and reviewed. Conclusion Intravenous TXA is established as an efficacious hemostatic agent in spinal surgery. Use of topical TXA in surgery suggests similar hemostatic efficacy and potentially improved safety as compared with intravenous TXA. For spinal surgery, the literature on topical TXA is sparse but promising, warranting further clinical investigation and consideration as a clinical option in cases with significant anticipated surgical site blood loss.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of TXA-mediated antifibrinolytic mechanisms in the intravascular lumen. Abbreviations: PLG, plasminogen; PL, plasmin; tPA, tissue plasminogen activator; TXA, tranexamic acid.
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FI1500075-1: Schematic representation of TXA-mediated antifibrinolytic mechanisms in the intravascular lumen. Abbreviations: PLG, plasminogen; PL, plasmin; tPA, tissue plasminogen activator; TXA, tranexamic acid.

Mentions: TXA is a synthetic lysine analogue that interferes with fibrinolysis through binding reversibly and competitively to lysine-binding domains on plasminogen, plasmin, and tissue plasminogen activator (Fig. 1).22 It chiefly works by attenuating the binding capacity of plasminogen and tissue plasminogen activator to fibrin, thereby decreasing the subsequent conversion of plasminogen to the enzymatically active serine protease plasmin, which leads to dissolution of fibrin clots.2324


Systemic and Topical Use of Tranexamic Acid in Spinal Surgery: A Systematic Review.

Winter SF, Santaguida C, Wong J, Fehlings MG - Global Spine J (2015)

Schematic representation of TXA-mediated antifibrinolytic mechanisms in the intravascular lumen. Abbreviations: PLG, plasminogen; PL, plasmin; tPA, tissue plasminogen activator; TXA, tranexamic acid.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4836933&req=5

FI1500075-1: Schematic representation of TXA-mediated antifibrinolytic mechanisms in the intravascular lumen. Abbreviations: PLG, plasminogen; PL, plasmin; tPA, tissue plasminogen activator; TXA, tranexamic acid.
Mentions: TXA is a synthetic lysine analogue that interferes with fibrinolysis through binding reversibly and competitively to lysine-binding domains on plasminogen, plasmin, and tissue plasminogen activator (Fig. 1).22 It chiefly works by attenuating the binding capacity of plasminogen and tissue plasminogen activator to fibrin, thereby decreasing the subsequent conversion of plasminogen to the enzymatically active serine protease plasmin, which leads to dissolution of fibrin clots.2324

Bottom Line: Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding.We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site.Use of topical TXA in surgery suggests similar hemostatic efficacy and potentially improved safety as compared with intravenous TXA.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, Charité University Medicine Berlin, Berlin, Germany.

ABSTRACT
Study Design Combination of narrative and systematic literature reviews. Objectives Massive perioperative blood loss in complex spinal surgery often requires blood transfusions and can negatively affect patient outcome. Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding. We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site. Through a systematic review of published and ongoing investigations on topical TXA for spinal surgery, we wish to make spine practitioners aware of this option and to suggest opportunities for further investigation in the field. Methods A narrative review of systemic TXA in spinal surgery and topical TXA in surgery was conducted. Furthermore, a systematic search (using PRISMA guidelines) of PubMed (MEDLINE), EMBASE, and Cochrane CENTRAL databases as well as World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov (National Institutes of Health), and International Standard Randomized Controlled Trial Number registries was conducted to identify both published literature and ongoing clinical trials on topical TXA in spinal surgery. Results Of 1,631 preliminary search results, 2 published studies were included in the systematic review. Out of 285 ongoing clinical trials matching the search criteria, a total of 4 relevant studies were included and reviewed. Conclusion Intravenous TXA is established as an efficacious hemostatic agent in spinal surgery. Use of topical TXA in surgery suggests similar hemostatic efficacy and potentially improved safety as compared with intravenous TXA. For spinal surgery, the literature on topical TXA is sparse but promising, warranting further clinical investigation and consideration as a clinical option in cases with significant anticipated surgical site blood loss.

No MeSH data available.


Related in: MedlinePlus