Limits...
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

Flow diagram depicting search strategy and study selection process used for systematic review. Abbreviations: RCT, randomized controlled trial; TXA, tranexamic acid.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4836933&req=5

FI1500075-2: Flow diagram depicting search strategy and study selection process used for systematic review. Abbreviations: RCT, randomized controlled trial; TXA, tranexamic acid.

Mentions: A total of 1,631 preliminary articles (RCTs, meta-analyses, and systematic reviews) matched our search criteria (n = 511 in Ovid EMBASE; n = 755 in Ovid MEDLINE; n = 365 in CENTRAL). The title and abstract of these articles were subsequently screened for subject relevance, revealing 76 potentially relevant articles (n = 20 in Ovid EMBASE; n = 29 in Ovid MEDLINE; n = 27 in CENTRAL), which were selected for whole-publication screening. Duplicates and studies using ivTXA (n = 74) were subsequently rejected, resulting in a total of 2 clinical studies on use of tTXA in spinal surgery (Fig. 2), for which data extraction, data analysis, and interpretation (including a judgment on risk of bias) were performed by the reviewers.


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)

Flow diagram depicting search strategy and study selection process used for systematic review. Abbreviations: RCT, randomized controlled trial; TXA, tranexamic acid.
© Copyright Policy
Related In: Results  -  Collection

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

FI1500075-2: Flow diagram depicting search strategy and study selection process used for systematic review. Abbreviations: RCT, randomized controlled trial; TXA, tranexamic acid.
Mentions: A total of 1,631 preliminary articles (RCTs, meta-analyses, and systematic reviews) matched our search criteria (n = 511 in Ovid EMBASE; n = 755 in Ovid MEDLINE; n = 365 in CENTRAL). The title and abstract of these articles were subsequently screened for subject relevance, revealing 76 potentially relevant articles (n = 20 in Ovid EMBASE; n = 29 in Ovid MEDLINE; n = 27 in CENTRAL), which were selected for whole-publication screening. Duplicates and studies using ivTXA (n = 74) were subsequently rejected, resulting in a total of 2 clinical studies on use of tTXA in spinal surgery (Fig. 2), for which data extraction, data analysis, and interpretation (including a judgment on risk of bias) were performed by the reviewers.

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