The Efficacy and Safety of Intravenous Tranexamic Acid in Reducing Surgical Blood Loss in Posterior Lumbar Interbody Fusion for the Adult: A Systematic Review and a Meta-Analysis

Objective To evaluate the efficacy and safety of tranexamic acid (TXA), we conducted a systematic review and meta-analysis of studies on intravenous TXA in posterior lumbar interbody fusion (PLIF) in adults. Methods We searched databases, including PubMed, EMBASE, and the Cochrane Library. The included articles, limited to English, compared intravenous TXA with placebo in adults who underwent PLIF. The methodologic quality of the studies was assessed using the following parameters: heterogeneity, weighted mean difference (WMD), relative risk, 95% confidence interval (CI), and subgroup analysis. Results Seven studies (5 randomized controlled trials and 2 nonrandomized controlled trials) were included in which 529 patients were treated by PLIF. We found that intravenous TXA can reduce total blood loss (WMD = –172.04, 95% confidence interval [CI] −204.70 to –139.37), intraoperative blood loss (WMD = –83.10, 95% CI −117.61 to –48.60), and postoperative blood loss (WMD = –83.10, 95% CI −117.61 to –48.60) but cannot reduce the blood transfusion rates (relative risk = 0.39; 95% CI 0.21–0.72). High-dose TXA could more effectively reduce the blood loss than the low-dose TXA. The risk of thrombotic events was not observed. Conclusions This meta-analysis showed that intravenous TXA can significantly reduce surgical blood loss and patients treated with TXA did not have a significant decrease in transfusion rates. Furthermore, it is safe and does not increase the risk of thrombotic events. We recommend intravenous TXA and the use of high-dose TXA during PLIF in adults. However, more high-quality and large-sample studies will be needed to confirm this result.