The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis
Abstract Background This study aims to evaluate the optimal dose of intravenous tranexamic acid (TXA) for reducing blood loss in spinal surgery. Methods A systematic search was conducted in the PubMed, Embase, Cochrane Library database from inception until November 2023. Randomized controlled trials...
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BMC
2024-12-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-024-08233-z |
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| author | Bo Shi Wenjuan Xie Jia Kai Lijun Li Lin Sun |
| author_facet | Bo Shi Wenjuan Xie Jia Kai Lijun Li Lin Sun |
| author_sort | Bo Shi |
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| description | Abstract Background This study aims to evaluate the optimal dose of intravenous tranexamic acid (TXA) for reducing blood loss in spinal surgery. Methods A systematic search was conducted in the PubMed, Embase, Cochrane Library database from inception until November 2023. Randomized controlled trials (RCTs) incorporating diverse TXA dosing regimens for spinal surgery were included. The surface under the cumulative ranking curve (SUCRA) analysis was employed to determine ranking order. R software with gemtc package was used for all analyses, with a significance threshold set at P < 0.05. Results Twenty-four RCTs were considered eligible and finally included. All TXA treatments demonstrated superior efficacy compared to the placebo, with statistically significant differences (P < 0.05). SUCRA values indicated that Treatment I (100 mg/kg + 10 mg.kg/h) claimed the top rank (SUCRA, 80.3%), followed by Treatment F (15 mg/kg + 2 mg.kg/h) in second place (SUCRA, 76.7%), and Treatment E (10 mg/kg + 2 mg.kg/h) in third place (SUCRA, 75.2%). Conversely, the placebo ranked the lowest (SUCRA, 0.3%). Additionally, Treatment I (100 mg/kg + 10 mg.kg/h) held the top rank (SUCRA, 95.6%), followed by Treatment N (30 mg/kg + 10 mg.kg/h) in second place (SUCRA, 81.0%), and Treatment K (15 mg/kg + 6 mg.kg/h) in third place (SUCRA, 74.8%). Importantly, no statistically significant differences were observed between any TXA treatments and the placebo concerning the occurrence of deep vein thrombosis (DVT) (P > 0.05). Conclusions This network meta-analysis underscores that intravenous TXA is associated with decreased overall blood loss in multilevel spine surgery. Notably, the highest dose in this network meta-analysis (100 mg/kg + 10 mg.kg/h) emerged as the only regimen demonstrating significant benefits in pairwise comparisons with other TXA doses. Although this regimen did not significantly increase DVT risk, careful consideration of safety data for higher doses remains essential. |
| format | Article |
| id | doaj-art-d5eeba4fc64d438c88f75b41388d76c6 |
| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-d5eeba4fc64d438c88f75b41388d76c62025-01-05T12:04:38ZengBMCBMC Musculoskeletal Disorders1471-24742024-12-0125111410.1186/s12891-024-08233-zThe optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysisBo Shi0Wenjuan Xie1Jia Kai2Lijun Li3Lin Sun4Department of Orthopaedics, Shanxi Provincial People’s Hospital, Shani Medical UniversityDepartment of Clinical Nutrition, Bethune Hospital, Shanxi Medical UniversityShanxi Medical UniversityDepartment of Orthopaedics, Shanxi Provincial People’s Hospital, Shani Medical UniversityShanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi HospitalAbstract Background This study aims to evaluate the optimal dose of intravenous tranexamic acid (TXA) for reducing blood loss in spinal surgery. Methods A systematic search was conducted in the PubMed, Embase, Cochrane Library database from inception until November 2023. Randomized controlled trials (RCTs) incorporating diverse TXA dosing regimens for spinal surgery were included. The surface under the cumulative ranking curve (SUCRA) analysis was employed to determine ranking order. R software with gemtc package was used for all analyses, with a significance threshold set at P < 0.05. Results Twenty-four RCTs were considered eligible and finally included. All TXA treatments demonstrated superior efficacy compared to the placebo, with statistically significant differences (P < 0.05). SUCRA values indicated that Treatment I (100 mg/kg + 10 mg.kg/h) claimed the top rank (SUCRA, 80.3%), followed by Treatment F (15 mg/kg + 2 mg.kg/h) in second place (SUCRA, 76.7%), and Treatment E (10 mg/kg + 2 mg.kg/h) in third place (SUCRA, 75.2%). Conversely, the placebo ranked the lowest (SUCRA, 0.3%). Additionally, Treatment I (100 mg/kg + 10 mg.kg/h) held the top rank (SUCRA, 95.6%), followed by Treatment N (30 mg/kg + 10 mg.kg/h) in second place (SUCRA, 81.0%), and Treatment K (15 mg/kg + 6 mg.kg/h) in third place (SUCRA, 74.8%). Importantly, no statistically significant differences were observed between any TXA treatments and the placebo concerning the occurrence of deep vein thrombosis (DVT) (P > 0.05). Conclusions This network meta-analysis underscores that intravenous TXA is associated with decreased overall blood loss in multilevel spine surgery. Notably, the highest dose in this network meta-analysis (100 mg/kg + 10 mg.kg/h) emerged as the only regimen demonstrating significant benefits in pairwise comparisons with other TXA doses. Although this regimen did not significantly increase DVT risk, careful consideration of safety data for higher doses remains essential.https://doi.org/10.1186/s12891-024-08233-zTranexamic acidDosing regimentsSpinal surgeryNetwork meta-analysisSystematic review |
| spellingShingle | Bo Shi Wenjuan Xie Jia Kai Lijun Li Lin Sun The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis BMC Musculoskeletal Disorders Tranexamic acid Dosing regiments Spinal surgery Network meta-analysis Systematic review |
| title | The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis |
| title_full | The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis |
| title_fullStr | The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis |
| title_full_unstemmed | The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis |
| title_short | The optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery: a network meta-analysis |
| title_sort | optimal dose of intravenous tranexamic acid for reducing blood loss in spinal surgery a network meta analysis |
| topic | Tranexamic acid Dosing regiments Spinal surgery Network meta-analysis Systematic review |
| url | https://doi.org/10.1186/s12891-024-08233-z |
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