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

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Pharmacology

Background:

• Massive perioperative blood loss in complex spinal surgery is a significant concern.
• Blood transfusions are often required, potentially impacting patient outcomes.
• Systemic tranexamic acid (TXA) is a widely used antifibrinolytic agent for surgical bleeding.

Purpose of the Study:

• To review the clinical evidence for intravenous TXA in spinal surgery.
• To discuss the emerging role of topical TXA as a complementary hemostatic agent.
• To identify published and ongoing research on topical TXA in spinal surgery.

Main Methods:

• A combination of narrative and systematic literature reviews was performed.
• Systematic searches followed PRISMA guidelines across major databases and clinical trial registries.
• Included studies focused on systemic and topical TXA for spinal surgery and general surgical bleeding.

Main Results:

• The systematic review identified 2 published studies on topical TXA in spinal surgery.
• Four relevant ongoing clinical trials were identified and reviewed.
• Intravenous TXA is an established hemostatic agent in spinal surgery.

Conclusions:

• Topical TXA demonstrates potential for hemostatic efficacy and improved safety compared to intravenous administration.
• The current literature on topical TXA for spinal surgery is limited but promising.
• Further clinical investigation is warranted to establish topical TXA as a viable option for managing surgical site blood loss.