The Efficacy of Tranexamic Acid on Blood Loss from Lumbar Spinal Fusion Surgery: A Meta-Analysis of Randomized Controlled Trials

INTRODUCTION: The efficacy of tranexamic acid to control blood loss from lumbar spinal fusion surgery remains controversial. We conducted a systematic review and meta-analysis to explore the influence of tranexamic acid on blood loss from lumbar spinal fusion surgery. METHODS: We searched PuhMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases through March 2018 for randomized controlled trials assessing the effect of tranexamic acid on blood loss from lumbar spinal fusion surgery. A meta-analysis was performed using the random-effect model. RESULTS: Six randomized controlled trials involving 394 patients were included in the meta-analysis. Overall, compared with control group for lumbar spinal fusion surgery, tranexamic acid significantly reduced intraoperative blood loss (standard mean difference [Std. MD] -0.32; 95% confidence interval [CI] -0.58 to -0.06; P = 0.02), and drain (Std. MD -1.12; 95% CI -1.59 to -0.64; P < 0.00001) but had no remarkable influence on hemoglobin (Std. MD -0.10; 95% CI -0.56 to 0.37; P = 0.68) and hematocrit (Std. MD -0.34; 95% CI -1.08 to 0.40; P = 0.37) 1 day after surgery and transfusion (risk ratio 0.44; 95% CI 0.16-1.19; P = 0.11). Duration of hospitalization was found to be shortened by tranexamic acid (Std. MD -1.00; 95% CI -1.68 to -0.32; P = 0.004). CONCLUSIONS: Tranexamic acid has an important ability to decrease intraoperative blood loss and hospitalization for lumbar spinal fusion surgery.