Meta-analysis of the safety and effectiveness of tranexamic acid in the posterior lumbar interbody fusion technique

English Keywords:Posterior lumbar interbody fusion  Tranexamic acid  Blood loss  Thrombosis  Meta analysis

English Abstract:

  【Abstract】 Objectives: To systematically analyze the efficacy and safety of tranexamic acid(TXA) hemostasis in patients undergoing posterior lumbar interbody fusion(PLIF) surgery. Methods: Researchers searched the databases of PubMed, Cochrane library, Web of Science, Embase, and Wanfang for randomized controlled trials (RCT) on the use of TXA in PLIF surgery. The retrieval time was from the establishment of the database to November 2019, and the language was not limited. The researchers assessed the quality of the included studies, and extracted the outcome indicators of each study(intraoperative blood loss, number of blood transfusions, total blood loss, drainage volume, operation time, and incidence of deep vein thrombosis) into an electronic baseline table. The data of these studies were analyzed and evaluated by Revma 5.3 software. Results: 11 RCTs were finally included in the study, with a total of 1,105 patients including 562 in the TXA group and 543 in the control group. The outcome indicators were compared: intraoperative blood loss: TXA group[MD=-53.9, 95%CI(-76.29, -31.51)] was lower than in the control group(P<0.05); The number of blood transfusion: The incidence of TXA group[OR=0.43, 95%CI(0.31, 0.61)] was lower than the latter(P<0.05); Total blood loss: TXA group[MD=-224.67, 95%CI(-313.60, -135.74)] lower than the latter(P<0.05); Drainage volume: TXA group[MD=-117.25, 95%CI(-126.21, -108.29)] lower than the latter(P<0.05); Operation time: TXA group[MD=-4.54, 95%CI (-7.69, -1.38)] slightly lower than the latter(P<0.005); Deep vein thrombosis: TXA group[OR=0.28, 95%CI (0.09, 0.80)] not significantly different from the latter(P>0.05). Conclusions: TXA in patients with degenerative lumbar disc herniation, stenosis or instability undergoing PLIF operation can reduce intraoperative blood loss, total blood loss, drainage, blood transfusion incidence rate and operation time, and will not increase thrombosis during PLIF operation the risk of forming an event.