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Efficacy and safety of topical versus intravenous tranexamic acid in spinal surgery: a systematic review and meta-analysis

BMC Surgery volume 25, Article number: 15 (2025) Cite this article

Abstract

Background

The relative efficacies of topical and intravenous tranexamic acid (TXA) in spinal surgery remain controversial. This meta-analysis aimed to compare the efficacy and safety of topical versus intravenous TXA in spinal surgery, with a particular focus on the impacts on intraoperative blood loss (IBL) and associated outcomes.

Methods

We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature related to topical and intravenous TXA in spinal surgery. Six trials met the inclusion criteria. The IBL, postoperative drainage volume, total blood loss, postoperative hematological variables, postoperative blood transfusions, and complications were analyzed.

Results

The meta-analysis of randomized controlled trials indicated that IBL and total blood loss were markedly higher in the group receiving topical TXA compared to the intravenous TXA group. Conversely, data from retrospective studies did not show significant differences between the two groups. Hemoglobin levels on postoperative days 1 and 3 were significantly lower in the topical TXA group than in the intravenous TXA group. No significant differences were observed between the topical and intravenous TXA groups regarding other postoperative hematological parameters, drainage volume, transfusion rates, and complications.

Conclusions

The current evidence suggests that topical TXA does not significantly reduce postoperative blood loss in spinal surgery compared with intravenous TXA, but has good safety and does not increase the associated risks. There is a need for high-quality studies that explore the effects of topical TXA in spinal surgery.

Peer Review reports

Introduction

With the continuous development of society, science, economy, and medical care, the number of operations has rapidly increased in recent years, and the number of patients who require spinal surgery for various diseases is also increasing [1, 2]. Especially in multi-segment, thoracic, and lumbar spinal surgery, the surgical incisions are deep and long and there are many muscle tissues to be peeled off, leaving large wounds and causing bleeding [3]. Heavy bleeding causes anemia, which delays wound healing or causes non-union, increases the probability of infection, and leads to increased surgical complications and perioperative mortality [4]. Therefore, it is important to reduce the bleeding caused by surgery. Various methods used clinically to reduce perioperative bleeding include improving surgical methods and techniques, shortening the operation time, autologous blood transfusion, and applying hemostatic drugs [5,6,7]; however, these methods cannot completely alleviate perioperative bleeding, and a large number of patients still need blood transfusions. Blood transfusion not only increases the incidences of infectious diseases and adverse reactions, but also increases medical costs and wastes blood resources [8,9,10]. The concept of Enhanced Recovery After Surgery is currently being advocated and includes the administration of hemostatic drugs to reduce perioperative bleeding, reduce complications, and shorten the length of hospital stay [11].

Tranexamic acid (TXA) is an antifibrinolytic type of hemostatic drug [12]. TXA achieves antifibrinolytic and hemostatic effects by binding to the lysine-binding site of plasminogen to competitively inhibit plasminogen adsorption on fibrin and activation of plasminogen, so that plasmin is not degraded by plasmin [4, 13]. TXA has been shown to reduce perioperative bleeding and the need for allogeneic blood transfusions [14, 15]. Itcan be administered orally, intravenously, or topically to achieve hemostasis [16,17,18]. Although intravenous TXA is commonly used, it has drawbacks, including a delayed onset of action (approximately 15 minutes) and an increased risk of venous thrombosis due to its antifibrinolytic effect [19, 20]. Topical TXA, however, has demonstrated promising results in surgeries such as hip and knee replacements and thoracic procedures, offering potential advantages over intravenous administration [21,22,23,24]. One study recommended topical TXA over intravenous TXA because high-dose intravenous TXA increases the incidence of postoperative venous thrombosis and pulmonary embolism, especially in patients with a history of embolism [25]. Compared with intravenous TXA, topical TXA directly aggregates at the site of action to directly and effectively exert a hemostatic effect, reduce systemic absorption, reduce the systemic effect of TXA, and eliminate the risk of venous thrombosis and cardiovascular and cerebrovascular diseases caused by intravenous TXA infusion [26, 27].

A number of unresolved issues regarding the potential risk of thrombosis, rare epileptogenic adverse effects, and contraindications to systemic TXA in patients with coagulopathy or renal impairment necessitate the use of topical TXA for bleeding management in spinal surgery. In addition, the fact that excessive fibrinolysis due to acute wasting coagulopathy caused by surgical trauma is concentrated in the surgical incision has aroused interest in exploring whether topical application of TXA may improve the current standard of treatment for hemostasis. The topical route of administration delivers hemostatic drugs directly to the wound during or at the end of surgery. Compared with non-TXA group, both topical and intravenous TXA significantly reduced the postoperative blood loss, blood transfusion rate, and postoperative hospital stay, but these variables did not differ between the topical and intravenous TXA groups [28]. However, intravenous TXA significantly reduced intraoperative bleeding compared with topical TXA [28]. Weissmann et al. retrospectively analyzed patients undergoing posterior fusion surgery and found no significant difference between the topical and intravenous TXA groups [29]. Wang et al. found that the total blood loss and intraoperative blood loss were significantly greater in the topical TXA group than the intravenous TXA group [30]. These previous findings suggest that both intravenous and topical TXA reduce f blood loss and transfusion rate during spinal surgery, while the best way to use TXA in spinal surgery is still debatable. Therefore, we performed a meta-analysis of existing studies to assess the effectiveness and safety of intravenous versus topical TXA in spinal surgery.

Methods

The study adheres to the standards outlined in the Cochrane Handbook for Systematic Reviews [31] and follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [32]. The protocol for this meta-analysis has been registered on PROSPERO (No: CRD 42023463198).

Inclusion criteria

Study type: randomized controlled trial (RCT) or non-RCT. Participants: Spinal surgery patients. Intervention and control: topical TXA vs. intravenous TXA. Outcomes: blood loss, postoperative hematological variables at 1 and 3 days after surgery, transfusions, and complications.

Search strategy

A comprehensive search was performed in PubMed, EMBASE, Medline, and the Cochrane Central Register of Controlled Trials from their inception to September 01, 2023. The keywords used were: “Intravenous and topical and tranexamic acid and (cervical or lumb* or thora* or spin*)”.

Study selection

Two researchers (CXX and GPC) independently screened the literature. They initially reviewed titles and abstracts, followed by a full-text review for those meeting the criteria. Disagreements were resolved by a senior researcher (HL).

Data collection process

Data extracted from the included studies encompassed: author and year, study design, country, sample size, participant details, TXA treatment specifics, age, and outcomes.

Assessment of risk of bias and quality of evidence

Two researchers (HL and CXX) independently assessed trial quality using the Cochrane risk-of-bias criteria [33] and the Newcastle–Ottawa scale for retrospective studies [34].

Data synthesis

Meta-analysis was conducted using Stata (version 17; StataCorp, 2021). Heterogeneity was assessed with the Q test and I² statistic. Random effect models were used. Dichotomous outcomes were measured using odds ratios (OR) with 95% confidence intervals (CI), and continuous outcomes were analyzed using standard mean difference (SMD).

Sensitivity analyses

We performed a sensitivity analysis by excluding individual trial.

Results

An initial total of 203 studies were identified. On the basis of the titles and abstracts, 87 duplicates were removed and 94 irrelevant studies were excluded. After the full text of 22 articles was read, a further 17 articles were excluded (3 meetings, 9 trials without results, and 5 studies that compared intravenous plus topical TXA with a control). An additional study was extracted from the reference list of a previous review. Finally, six studies (5 RCTs and 1 retrospective study) with a total of 518 patients were included in our study. The study by Arun-Kumar et al. was divided into three groups, and the group that received local TXA before the skin incision was excluded from our study [35]. Figure 1 shows the screening process, and Table 1 summarizes the characteristics of the included studies.

Fig. 1
figure 1

Flow diagram for search and selection of included studies

Full size image
Table 1 Characteristics of included studies
Full size table

Intraoperative blood loss

Six studies (5 RCTs and 1 retrospective study) assessed the intraoperative blood loss (IBL) [28,29,30, 35,36,37]. Meta-analysis of the RCTs showed that IBL was significantly greater in the topical TXA group than the intravenous TXA group SMD 1.16, 95% CI 0.38 to 1.94, I2 = 93.0%, P = 0.004; Table 2). In the retrospective study, there was no significant difference in IBL between the topical TXA and intravenous TXA groups (SMD − 0.26, 95% CI − 0.78 to 0.27, P = 0.335; Table 2).

Table 2 Pooled effect size and heterogeneity tests outcomes including IBL, TBL, postoperative drainage, postoperative hematological variables, postoperative blood transfusions, and complication using the random-effects model
Full size table

Total blood loss

Three studies (2 RCTs and 1 retrospective study) reported the total blood loss (TBL) [29, 30, 36]. Analysis of the RCTs using a random-effects model showed that TBL was significantly greater in the topical TXA group than the intravenous TXA group (SMD 0.52, 95% CI 0.05 to 0.99, I2 = 72.1%, P = 0.03; Table 2). In the retrospective study, there was no significant difference in TBL between groups (SMD − 0.25, 95% CI -0.78 to 0.27, P = 0.335; Table 2).

Postoperative drainage

Four studies (3 RCTs and 1 retrospective study) reported the postoperative drainage volume [28, 29, 35, 36]. In the RCTs, there was no significant difference in total postoperative drainage between the topical TXA and intravenous TXA groups (SMD 0.54, 95% CI -0.06 to 1.14, I2 = 81.6%, P = 0.077; Table 2). The conclusions of the retrospective study were consistent with those of the RCTs.

Postoperative hematological variables at 1 and 3 days after surgery

One RCT reported the hemoglobin (Hb) concentration on postoperative day 1 [35], two RCTs reported Hb concentrations on postoperative day 3 [28, 35], one RCT reported the hematocrit value (HCT) on postoperative day 1 [35], three RCTs reported the HCT on postoperative day 3 [28, 30, 35], and one RCT reported the postoperative D-dimer concentrations [30]. The Hb concentration on postoperative day 1 was significantly lower in the topical TXA group than the intravenous TXA group (SMD − 1.214, 95% CI -1.807 to -0.621, P < 0.001; Table 2). There was no significant difference in Hb levels between the two groups on postoperative day 3 (SMD − 2.30, 95% CI -5.94 to 1.33, I2 = 97.8%, P = 0.215; Table 2). There was no significant difference in the HCT between the two groups on postoperative day 1 (SMD − 0.38, 95% CI -0.93 to 0.17, P = 0.174; Table 2). However, the HCT on postoperative day 3 was significantly lower in the topical TXA group than the intravenous TXA group (SMD − 0.77, 95% CI -1.44 to -0.09, I2 = 84.7%, P = 0.027; Table 2). There was no difference between the two groups in the D-dimer concentration (SMD − 0.052, 95% CI -0.41 to 0.30, P = 0.775; Table 2).

Postoperative blood transfusions

Postoperative blood transfusions were reported in four RCTs [28, 30, 35, 36]. Data from Wang et al. were excluded due to the absence of events [30]. The pooled analysis revealed no significant difference in transfusions rates between topical and intravenous TXA groups (OR: 0.89, 95% CI: 0.48 to 1.69, I2 = 0%, P = 0.727; Table 2).

Complications

Four RCTs reported complications [28, 30, 36, 37]. Mu et al. and Wang et al. reported no related adverse reaction events in either group [28, 30]. The pooled results showed no significant difference in postoperative complications between the topical and intravenous TXA groups (OR: 0.86, 95% CI: 0.31 to 2.42, I2 = 0%, P = 0.781; Table 2).

Sensitivity analysis

The remaining studies were pooled when any individual study was excluded, and no single study significantly affected the results.

Publication bias

Publication bias was not assessed due to fewer than 10 trials.

Discussion

We conducted a meta-analysis of six studies with a total of 518 patients who received either topical or intravenous TXA administration in spinal surgery. The five included RCTs had a high quality of evidence. An analysis of the data from these five RCTs found that topical TXA did not significantly reduce IBL and TBL during spinal surgery compared with intravenous TXA. However, this relates to the timing of topical application rather than the method of drug use. In the studies we included, topical application of TXA was performed at the end of surgery. This timing may not effectively prevent intraoperative bleeding. In contrast, intravenous TXA is usually administered before the start of surgery, thus providing suppression of the systemic fibrinolytic system throughout the operation. Therefore, the inability of topical TXA to reduce intraoperative blood loss may be due to its timing of use. To better assess the efficacy of topical TXA, we recommend injecting it locally before the start of surgery and using TXA-soaked gauzes intraoperatively for local hemostasis. Such methods might more effectively reduce bleeding in surrounding tissues during surgery. By administering the drug in advance and maintaining its application during surgery, local fibrinolytic activity can be better suppressed, thereby reducing intraoperative bleeding. Our review included only one retrospective study. Retrospective studies are often subject to a number of limitations, such as selection bias, information bias, and confounding bias, which makes the quality of the evidence relatively low. Therefore, the conclusions of a retrospective study may not be sufficiently credible and are susceptible to bias and statistical uncertainty. Although the findings of this retrospective study differed from the findings of the RCTs and concluded that the total and intraoperative blood loss was similar in the topical and intravenous TXA groups, this conclusion needs to be interpreted with caution due to the low level of evidence and small sample size of the retrospective study. As RCTs have a higher quality and quantity of evidence, their results are considered more reliable. The conclusions of retrospective studies may be valuable, but need to be interpreted with caution as their methodological limitations may result in less stable conclusions. Overall, there is a need for more high-quality RCTs to fully assess the effect of topical TXA on blood loss in spinal surgery to improve our understanding and guide clinical practice.

Our meta-analysis showed no significant difference in total postoperative drainage between the topical and intravenous TXA groups in the RCTs. This result was also validated in the retrospective study. In terms of postoperative blood variables, we found that the Hb concentration was significantly lower in the topical TXA group than the intravenous TXA group on postoperative day 1. However, this difference was no longer significant on postoperative day 3. In contrast, the HCT significantly differed between groups on postoperative day 3 but not on postoperative day 1. This may reflect differences between the two groups in blood recovery in the days after surgery. Although the Hb concentration significantly differed between the two groups on postoperative day 1, further research is needed to determine whether this finding has practical implications for clinical outcomes. Finally, our analysis did not find a significant difference between the topical and intravenous TXA groups in the incidences of blood transfusion and complications. Overall, the current findings suggest that topical TXA has a poor effect on blood preservation compared with intravenous TXA. This is consistent with the conclusions of Cao et al. [38].

Xiong et al. analyzed eight RCTs on nondeformity spinal surgery, finding no differences between topical and intravenous TXA in blood loss, HCT, Hb, fibrinogen, prothrombin time, partial thromboplastin time, drainage volume, or transfusion rate [39]. Our study included two studies of patients with spinal deformities. The large degree of trauma and bleeding in surgery for spinal deformities may be the reason for the different conclusions of these two studies. However, another important factor is that the studies included by Xiong et al. were all published by Chinese scholars [39]; therefore, there may have been publication bias. Although topical TXA is less effective than intravenous TXA in the hem sparing effect, studies have shown that topical TXA has a high efficacy in reducing blood loss and drainage volume compared with patients who did not receive TXA, and enables a rapid recovery with a high safety profile in spinal surgery [40].

Limitations

Our study has several limitations. First, it included only six studies (5 RCTs and 1 retrospective study), each with a small sample size, which may limit the statistical power and generalizability. Second, high heterogeneity was observed in the analyses of IBL, TBL, and day 3 Hb values, likely due to variations in patient populations, surgical techniques, TXA doses, or other factors. Third, publication bias could not be assessed due to fewer than 10 studies. Fourth, differences in TXA administration methods (e.g., injection [36], irrigation [29, 35], soaked sponges [37]) and doses across studies may impact the consistency and interpretation of the results. Considering that only six studies were included, we were limited in our ability to conduct subgroup analyses based on the dosage and use of TXA to explore the impact of different doses and use on bleeding control. Therefore, future research should further investigate the optimal dosage and administration methods of TXA to enhance its effectiveness in spinal surgery. Fifth, participant differences across studies may introduce heterogeneity, bias, and limit generalization, impacting the interpretation and applicability of pooled results. This requires carefully statistical analysis to ensure confidence and clinical utility. Varying TXA doses can affect outcomes, needing careful consideration. Due to the small number of studies, subpopulation analysis was not possible. Future research focusing on consistent TXA doses or regimens may provide more robust conclusions.

Conclusions

On the basis of the current evidence, topical TXA was not found to significantly reduce postoperative blood loss compared with intravenous TXA. However, the safety of topical TXA was confirmed without increasing the associated risk of blood clots. Although topical TXA does not achieve the same efficacy as intravenous TXA, it still reduces bleeding compared with no TXA. However, heterogeneity was observed between studies, with outcomes varying across study types. Future research should explore the effects of TXA in diverse populations and surgical procedures to better understand its role and applicability in spinal surgery.

Data availability

No datasets were generated or analysed during the current study.

References

  1. Liu JH, Etzioni DA, O’Connell JB, Maggard MA, Ko CY. The increasing workload of general surgery. Arch Surg. 2004;139:423–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/archsurg.139.4.423.

    Article  PubMed  Google Scholar 

  2. Grotle M, Småstuen MC, Fjeld O, Grøvle L, Helgeland J, Storheim K, Solberg TK, Zwart JA. Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open. 2019;9:e028743. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2018-028743.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zhang Y, Wang W, Bai L, Hao D. A comparison of outcomes between the Wiltse Approach with Pedicle Screw Fixation and the Percutaneous pedicle screw fixation for Multi-segmental Thoracolumbar fractures. Orthop Surg. 2023;15:2363–72. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/os.13816.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hsieh PW, Chen WY, Aljuffali IA, Chen CC, Fang JY. Co-drug strategy for promoting skin targeting and minimizing the transdermal diffusion of hydroquinone and tranexamic acid. Curr Med Chem. 2013;20:4080–92. https://doiorg.publicaciones.saludcastillayleon.es/10.2174/15672050113109990202.

    Article  CAS  PubMed  Google Scholar 

  5. (2015) Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology 122:241–75. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/aln.0000000000000463

  6. Le Huec JC, AlEissa S, Bowey AJ, Debono B, El-Shawarbi A, Fernández-Baillo N, Han KS, Martin-Benlloch A, Pflugmacher R, Sabatier P, Vanni D, Walker I, Warren T, Litrico S. Hemostats in spine surgery: Literature Review and Expert Panel recommendations. Neurospine. 2022;19:1–12. https://doiorg.publicaciones.saludcastillayleon.es/10.14245/ns.2143196.598.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stejskal P, Trnka Š, Hrabálek L, Wanek T, Jablonský J, Novák V. [Effects of Tranexamic Acid on Perioperative Blood loss and wound hematoma development in lumbar spine surgery: a prospective Randomized Study]. Acta Chir Orthop Traumatol Cech. 2023;90:176–80.

    Article  CAS  PubMed  Google Scholar 

  8. Ackfeld T, Schmutz T, Guechi Y, Le Terrier C. Blood transfusion Reactions-A Comprehensive Review of the literature including a Swiss perspective. J Clin Med. 2022;11. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm11102859.

  9. Fisahn C, Jeyamohan S, Norvell DC, Tubbs RS, Moisi M, Chapman JR, Page J, Oskouian RJ. Association between Allogeneic Blood Transfusion and postoperative infection in major spine surgery. Clin Spine Surg. 2017;30:E988–92. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/bsd.0000000000000539.

    Article  PubMed  Google Scholar 

  10. Shander A. Emerging risks and outcomes of blood transfusion in surgery. Semin Hematol. 2004;41:117–24. https://doiorg.publicaciones.saludcastillayleon.es/10.1053/j.seminhematol.2003.11.023.

    Article  PubMed  Google Scholar 

  11. Wang HY, Wang L, Luo ZY, Wang D, Tang X, Zhou ZK, Pei FX. Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial. BMC Musculoskelet Disord. 2019;20:478. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12891-019-2885-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wellington K, Wagstaff AJ. Tranexamic acid: a review of its use in the management of menorrhagia. Drugs. 2003;63:1417–33. https://doiorg.publicaciones.saludcastillayleon.es/10.2165/00003495-200363130-00008.

    Article  CAS  PubMed  Google Scholar 

  13. Hao S, Li H, Liu S, Meng S, Zhang X, Wang L, Yang H, Zhang L, Dong S. The effect of intravenous unit-dose tranexamic acid on visible and hidden blood loss in posterior lumbar interbody fusion: a randomized clinical trial. Sci Rep. 2023;13:4714. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41598-022-27307-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Patel PA, Wyrobek JA, Butwick AJ, Pivalizza EG, Hare GMT, Mazer CD, Goobie SM. Update on Applications and limitations of Perioperative Tranexamic Acid. Anesth Analg. 2022;135:460–73. https://doiorg.publicaciones.saludcastillayleon.es/10.1213/ane.0000000000006039.

    Article  PubMed  Google Scholar 

  15. Lu VM, Ho YT, Nambiar M, Mobbs RJ, Phan K. The Perioperative Efficacy and Safety of Antifibrinolytics in adult spinal Fusion surgery: a systematic review and Meta-analysis. Spine (Phila Pa 1976). 2018;43:E949–58. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/brs.0000000000002580.

    Article  PubMed  Google Scholar 

  16. Yu CC, Fidai M, Washington T, Bartol S, Graziano G. Oral is as effective as intravenous tranexamic acid at reducing blood loss in Thoracolumbar spinal fusions: a prospective Randomized Trial. Spine (Phila Pa 1976). 2022;47:91–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/brs.0000000000004157.

    Article  PubMed  Google Scholar 

  17. Yu CC, Kadri O, Kadado A, Buraimoh M, Pawloski J, Bartol S, Graziano G. Intravenous and oral tranexamic acid are equivalent at reducing blood loss in Thoracolumbar spinal Fusion: a prospective Randomized Trial. Spine. 2019;44:755–61. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/BRS.0000000000002954.

    Article  PubMed  Google Scholar 

  18. Ren Z, Li S, Sheng L, Zhuang Q, Li Z, Xu D, Chen X, Jiang P, Zhang X. Efficacy and safety of topical use of Tranexamic Acid in reducing blood loss during primary lumbar spinal surgery. Spine. 2017;42:1779–84. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/BRS.0000000000002231.

    Article  PubMed  Google Scholar 

  19. Ker K, Roberts I. Tranexamic acid for surgical bleeding. BMJ. 2014;349:g4934. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmj.g4934.

    Article  CAS  PubMed  Google Scholar 

  20. Lin ZX, Woolf SK. Safety, Efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery. Orthopedics. 2016;39:119–30. https://doiorg.publicaciones.saludcastillayleon.es/10.3928/01477447-20160301-05.

    Article  PubMed  Google Scholar 

  21. Shen L, Jiang Z, Wang Q, Xu W. Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2023;24:455. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12891-023-06576-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Fang Y, Shang X. Comparison of intravenous versus topical tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of ten randomized trials. J Comp Eff Res. 2021;10:1089–102. https://doiorg.publicaciones.saludcastillayleon.es/10.2217/cer-2021-0084.

    Article  PubMed  Google Scholar 

  23. Masaryk J, Melus V, Vidan J, Steno B. Comparison of Intravenous and Topical Tranexamic Acid in Total Joint Arthroplasty. Acta Chir Orthop Traumatol Cech. 2022;89:286–92.

    Article  CAS  PubMed  Google Scholar 

  24. Hatami F, Valizadeh N, Salehi F, Hosseinzadeh Maleki M. Topical versus low-dose systemic tranexamic acid in pediatric cardiac surgery: a randomized clinical study. J Card Surg. 2020;35:3368–73. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jocs.15082.

    Article  PubMed  Google Scholar 

  25. Motififard M, Tahririan MA, Saneie M, Badiei S, Nemati A. Low dose Perioperative Intravenous Tranexamic Acid in patients undergoing total knee arthroplasty: a double-blind randomized placebo controlled clinical trial. J Blood Transfus. 2015;2015(948304). https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2015/948304.

  26. Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, Syed KA, Muhammad Ovais Hasan S, De Silva Y, Chung F. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010;92:2503–13. https://doiorg.publicaciones.saludcastillayleon.es/10.2106/jbjs.I.01518.

    Article  PubMed  Google Scholar 

  27. George S, Ramchandran S, Mihas A, George K, Mansour A, Errico T. Topical tranexemic acid reduces intra-operative blood loss and transfusion requirements in spinal deformity correction in patients with adolescent idiopathic scoliosis. Spine Deform. 2021;9:1387–93. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s43390-021-00337-z.

    Article  PubMed  Google Scholar 

  28. Mu X, Wei J, Wang C, Ou Y, Yin D, Liang B, Qiu D, Li Z. Intravenous administration of Tranexamic Acid significantly reduces visible and hidden blood loss compared with its Topical Administration for double-segment posterior lumbar Interbody Fusion: a Single-Center, Placebo-Controlled, Randomized Trial. World Neurosurg. 2019;122:e821–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.wneu.2018.10.154.

    Article  PubMed  Google Scholar 

  29. Weissmann KA, Lafage V, Barrios Pitaque C, Lafage R, Descazeaux FM. Efficacy of topical versus intravenous tranexamic acid in spinal deformity. Eur Spine J. 2020;29:3044–50. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00586-020-06572-8.

    Article  PubMed  Google Scholar 

  30. Wang X, Yang R, Sun H, Zhang Y. Different effects of Intravenous, Topical, and combined application of Tranexamic Acid on patients with Thoracolumbar fracture. World Neurosurg. 2019;127:e1185–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.wneu.2019.04.095.

    Article  PubMed  Google Scholar 

  31. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmj.d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/journal.pmed.1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:Ed000142. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/14651858.Ed000142.

    Article  PubMed  Google Scholar 

  34. Wells G, Shea B, O’Connell J. The Newcastle-Ottawa Scale (NOS) for assessing the quality of Nonrandomised studies in Meta-analyses. Ottawa Health Research Institute Web site 7; 2014.

  35. Arun-Kumar V, Naresh-Babu J. Is there a role for preoperative local infiltration of Tranexamic Acid in Elective spine surgery? A prospective randomized controlled trial analyzing the efficacy of Intravenous, local infiltration, and Topical Administration of Tranexamic Acid. Global Spine J. 2021;11:21–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/2192568219888446.

    Article  PubMed  Google Scholar 

  36. Li J, Wang L, Bai T, Liu Y, Huang Y. Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion. J Orthop Surg Res. 2020;15:339. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13018-020-01758-8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. El-Sharkawi M, Sayed S, Gad W, El-Meshtawy M. Effect of topical versus parentral tranexamic acid on blood loss in spinal deformity surgery. Global Spine J. 2016;6(s–0036–1582659–s–1580036–1582659). https://doiorg.publicaciones.saludcastillayleon.es/10.1055/s-0036-1582659. A Prospective Randomized Controlled Trial.

  38. Cao Z, Li Q, Guo J, Li Y, Wu J. Optimal administration strategies of tranexamic acid to minimize blood loss during spinal surgery: results of a bayesian network meta-analysis. Ann Med. 2022;54:2053–63. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/07853890.2022.2101687.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Xiong Z, Liu J, Yi P, Wang H, Tan M. Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity spine surgery: a Meta-analysis. Biomed Res Int. 2020;2020(7403034). https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2020/7403034.

  40. Guo T, Xuan W, Feng H, Wang J, Ma X. The efficacy and safety of Topical Tranexamic Acid for spinal surgery. Curr Pharm Des. 2021;27:4496–503. https://doiorg.publicaciones.saludcastillayleon.es/10.2174/1381612827666210713160016.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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Author notes

  1. Chengxin Xie, Liwei Zhang, Guoping Cai and Yongwei Su contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, China

    Chengxin Xie, Liwei Zhang, Guoping Cai, Peng Wang & Hua Luo

  2. Department of Orthopedic, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121000, China

    Yongwei Su

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  1. Chengxin Xie
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  2. Liwei Zhang
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Contributions

HL and CXX conceptualized the study; HL, CXX, GPC and LWZ performed the selection, data extraction, and risk of bias assessment; HL performed the statistical analysis and drafted the manuscript; PW and CXX provided critical appraisal of the manuscript. YWS helped revised the manuscript.All authors reviewed and agreed on the final version of the manuscript.

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Correspondence to Hua Luo.

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Xie, C., Zhang, L., Cai, G. et al. Efficacy and safety of topical versus intravenous tranexamic acid in spinal surgery: a systematic review and meta-analysis. BMC Surg 25, 15 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12893-024-02743-2

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12893-024-02743-2

Keywords

BMC Surgery

ISSN: 1471-2482

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