{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:22:26Z","timestamp":1789471346340,"version":"build-2803163510"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Tranexamic acid (TXA) is an FDA-approved antifibrinolytic that is seeing increased popularity in spine surgery owing to its ability to reduce intraoperative blood loss (IOBL) and allogeneic transfusion requirements. The present study aimed to summarize the current literature on these formulations in the context of short-segment instrumented lumbar fusion including \u2265 1-level posterior lumbar interbody fusion (PLIF).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The PubMed, Cochrane, and Web of Science databases were queried for all full-text English studies evaluating the use of topical TXA (tTXA), systemic TXA (sTXA), or combined tTXA+sTXA in patients undergoing PLIF. The primary endpoints of interest were operative time, IOBL, and total blood loss (TBL); secondary endpoints included venous thromboembolic complication occurrence, and allogeneic and autologous transfusion requirements. Outcomes were compared using random effects. Comparisons were made between the following treatment groups: sTXA, tTXA, and sTXA+tTXA. Given that sTXA is arguably the standard of care in the literature (i.e., the most common route of administration that to this point has been studied the most), the authors compared sTXA versus tTXA and sTXA versus sTXA+tTXA. Study heterogeneity was assessed with the I<jats:sup>2<\/jats:sup> test, and grouped analysis using the Hedge\u2019s g test was performed for measurement of effect size.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Forty-five articles were identified, of which 17 met the criteria for inclusion with an aggregate of 1008 patients. TXA regimens included sTXA only, tTXA only, and various combinations of sTXA and tTXA. There were no significant differences in operative time, TBL, or postoperative drainage between the sTXA and tTXA groups or between the sTXA and sTXA+tTXA groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The present meta-analysis suggested clinical equipoise between isolated sTXA, isolated tTXA, and combinatorial tTXA+sTXA formulations as hemostatic adjuvants\/neoadjuvants in short-segment fusion including \u2265 1-level PLIF. Given the theoretically lower venous thromboembolism risk associated with tTXA, additional investigations using large cohorts comparing these two formulations within the posterior fusion population are merited. Although TXA has been shown to be effective, there are insufficient data to support topical or systemic administration as superior within the open PLIF population.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.2.spine23779","type":"journal-article","created":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T02:02:36Z","timestamp":1715997756000},"page":"224-235","source":"Crossref","is-referenced-by-count":5,"title":["Effect of the administration route on the hemostatic efficacy of tranexamic acid in patients undergoing short-segment posterior lumbar interbody fusion: a systematic review and meta-analysis"],"prefix":"10.3171","volume":"41","author":[{"given":"Matthew J.","family":"Hatter","sequence":"first","affiliation":[{"name":"Departments of Orthopedic Surgery and"},{"name":"University of California Irvine School of Medicine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy I.","family":"Hsu","sequence":"additional","affiliation":[{"name":"University of California Irvine School of Medicine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Shooshani","sequence":"additional","affiliation":[{"name":"University of California Irvine School of Medicine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Yale","sequence":"additional","affiliation":[{"name":"University of California Irvine School of Medicine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omead","family":"Pooladzandi","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, University of California, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean S.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"},{"name":"University of California Irvine School of Medicine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce","family":"Picton","sequence":"additional","affiliation":[{"name":"University of California Irvine School of Medicine, Irvine, California;"},{"name":"Neurosurgery, University of California Irvine, Orange, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlena","family":"Ramanis","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"},{"name":"University of California Irvine School of Medicine, Irvine, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nolan J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Neurosurgery, University of California Irvine, Orange, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohaib","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Po","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin H.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California\u2013San Diego School of Medicine, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","article-title":"Utility of tranexamic acid (TXA) for resection of intracranial meningiomas: a systematic review and meta-analysis","author":"Brown N","unstructured":"Brown N, Nguyen B, Nguyen A,  Utility of tranexamic acid (TXA) for resection of intracranial meningiomas: a systematic review and meta-analysis. Poster presented at: Society for Neuro-Oncology 27th Annual Meeting; November 16\u201320, 2022; Tampa, FL. Accessed March 16, 2024. https:\/\/www.researchgate.net\/publication\/365130431_Utility_of_Tranexamic_Acid_TXA_for_Resection_of_Intracranial_Meningiomas_A_Systematic_Review_and_Meta-analysis"},{"key":"b2","series-title":"Geriatr Orthop Surg Rehabil","first-page":"21514593221098606","article-title":"Encouragement for further study of tranexamic acid administration for sacroiliac joint fusion surgery","volume":"13","author":"Beyer RS","year":"2022","unstructured":"Beyer RS, Hatter MJ, Streetman D, Brown N, Gendreau J. Encouragement for further study of tranexamic acid administration for sacroiliac joint fusion surgery. Geriatr Orthop Surg Rehabil. 2022;13:21514593221098606."},{"key":"b3","series-title":"World Neurosurg","first-page":"e209","article-title":"Use of tranexamic acid for elective resection of intracranial neoplasms: a systematic review","volume":"160","author":"Brown NJ","year":"2022","unstructured":"Brown NJ, Wilson B, Ong V,  Use of tranexamic acid for elective resection of intracranial neoplasms: a systematic review. World Neurosurg. 2022;160:e209\u2013e219."},{"issue":"4","key":"b4","series-title":"J Neurosurg Spine","first-page":"686","article-title":"Association of tranexamic acid with decreased blood loss in patients undergoing laminectomy and fusion with posterior instrumentation: a systematic review and meta-analysis","volume":"36","author":"Brown NJ","year":"2021","unstructured":"Brown NJ, Choi EH, Gendreau JL,  Association of tranexamic acid with decreased blood loss in patients undergoing laminectomy and fusion with posterior instrumentation: a systematic review and meta-analysis. 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Spine J. 2013;13(8):877\u2013881."},{"issue":"3","key":"b7","series-title":"J Am Acad Orthop Surg","first-page":"132","article-title":"Antifibrinolytics in major orthopaedic surgery","volume":"18","author":"Eubanks JD","year":"2010","unstructured":"Eubanks JD. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg. 2010;18(3):132\u2013138."},{"issue":"6","key":"b8","series-title":"BJS Open","first-page":"840","article-title":"Cytotoxicity and effect on wound re-epithelialization after topical administration of tranexamic acid","volume":"3","author":"Eikebrokk TA","year":"2019","unstructured":"Eikebrokk TA, Vassmyr BS, Ausen K, Gravastrand C, Spigset O, Pukstad B. Cytotoxicity and effect on wound re-epithelialization after topical administration of tranexamic acid. BJS Open. 2019;3(6):840\u2013851."},{"issue":"7","key":"b9","series-title":"J Clin Med","first-page":"1415","article-title":"The effect of tranexamic acid administration on early endothelial damage following posterior lumbar fusion surgery","volume":"10","author":"Kim HJ","year":"2021","unstructured":"Kim HJ, Lee B, Lee BH, Kim SY, Jun B, Choi YS. The effect of tranexamic acid administration on early endothelial damage following posterior lumbar fusion surgery. J Clin Med. 2021;10(7):1415."},{"issue":"10","key":"b10","series-title":"Int Orthop","first-page":"2079","article-title":"Combined use of tranexamic acid and rivaroxaban in posterior lumbar interbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis\u2014a prospective, stratified, randomized, controlled trial","volume":"44","author":"Zhang L","year":"2020","unstructured":"Zhang L, Li Y, Liu D,  Combined use of tranexamic acid and rivaroxaban in posterior lumbar interbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis\u2014a prospective, stratified, randomized, controlled trial. Int Orthop. 2020;44(10):2079\u20132087."},{"issue":"1","key":"b11","series-title":"J Orthop Surg Res","first-page":"339","article-title":"Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion","volume":"15","author":"Li J","year":"2020","unstructured":"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(1):339."},{"issue":"11","key":"b12","series-title":"Eur Spine J","first-page":"2851","article-title":"The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study","volume":"26","author":"Kim KT","year":"2017","unstructured":"Kim KT, Kim CK, Kim YC,  The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J. 2017;26(11):2851\u20132857."},{"issue":"5","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"E267","article-title":"Effectiveness and safety of batroxobin, tranexamic acid and a combination in reduction of blood loss in lumbar spinal fusion surgery","volume":"43","author":"Nagabhushan RM","year":"2018","unstructured":"Nagabhushan RM, Shetty AP, Dumpa SR, Subramanian B, Kanna RM, Shanmuganathan R. Effectiveness and safety of batroxobin, tranexamic acid and a combination in reduction of blood loss in lumbar spinal fusion surgery. Spine (Phila Pa 1976). 2018;43(5):E267\u2013E273."},{"key":"b14","series-title":"World Neurosurg","first-page":"e198","article-title":"The efficacy and safety of prophylactic intravenous tranexamic acid on perioperative blood loss in patients treated with posterior lumbar interbody fusion","volume":"125","author":"Sun H","year":"2019","unstructured":"Sun H, Deng L, Deng J,  The efficacy and safety of prophylactic intravenous tranexamic acid on perioperative blood loss in patients treated with posterior lumbar interbody fusion. 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Medicine (Baltimore). 2020;99(11):e19552."},{"issue":"1","key":"b18","series-title":"Medicine (Baltimore)","first-page":"e5718","article-title":"Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis: a randomized trial","volume":"96","author":"Shi H","year":"2017","unstructured":"Shi H, Ou Y, Jiang D, Quan Z, Zhao Z, Zhu Y. Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis: a randomized trial. Medicine (Baltimore). 2017;96(1):e5718."},{"issue":"42","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e8233","article-title":"Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: a retrospective study","volume":"96","author":"Ren Z","year":"2017","unstructured":"Ren Z, Li S, Sheng L,  Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: a retrospective study. Medicine (Baltimore). 2017;96(42):e8233."},{"issue":"2","key":"b20","series-title":"Surg Innov","first-page":"128","article-title":"Clinical research of combined intravenous administration and topical application of tranexamic acid to a surgical wound during posterior lumbar fusion","volume":"25","author":"Ou Y","year":"2018","unstructured":"Ou Y, Wei J, Li R,  Clinical research of combined intravenous administration and topical application of tranexamic acid to a surgical wound during posterior lumbar fusion. Surg Innov. 2018;25(2):128\u2013135."},{"issue":"2","key":"b21","series-title":"J Neurosurg Spine","first-page":"177","article-title":"Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies","volume":"33","author":"Ehresman J","year":"2020","unstructured":"Ehresman J, Pennington Z, Schilling A,  Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies. J Neurosurg Spine. 2020;33(2):177\u2013185."},{"key":"b22","series-title":"BMC Surg","first-page":"29","article-title":"Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study","volume":"11","author":"Endres S","year":"2011","unstructured":"Endres S, Heinz M, Wilke A. Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study. BMC Surg. 2011;11:29."},{"issue":"3-4","key":"b23","series-title":"Thai J Orthop Surg","first-page":"1","article-title":"Tranexamic acid in reducing perioperative blood loss in lumbar spinal stenosis surgery: a double-blind randomized controlled trial","volume":"35","author":"Suksamosorn P","year":"2011","unstructured":"Suksamosorn P, Suarjui J, Lewsiriat S. Tranexamic acid in reducing perioperative blood loss in lumbar spinal stenosis surgery: a double-blind randomized controlled trial. Thai J Orthop Surg. 2011;35(3-4):1\u20137."},{"key":"b24","series-title":"World Neurosurg","first-page":"e621","article-title":"Safety and efficacy of topical administration of tranexamic acid in high-risk patients undergoing posterior lumbar interbody fusion surgery","volume":"151","author":"Shi P","year":"2021","unstructured":"Shi P, Wang J, Cai T,  Safety and efficacy of topical administration of tranexamic acid in high-risk patients undergoing posterior lumbar interbody fusion surgery. World Neurosurg. 2021;151:e621\u2013e629."},{"key":"b25","series-title":"World Neurosurg","first-page":"e821","article-title":"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","volume":"122","author":"Mu X","year":"2019","unstructured":"Mu X, Wei J, Wang C,  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\u2013e827."},{"issue":"4","key":"b26","series-title":"Innov Aging","first-page":"igz036","article-title":"Effect size guidelines, sample size calculations, and statistical power in gerontology","volume":"3","author":"Brydges CR","year":"2019","unstructured":"Brydges CR. Effect size guidelines, sample size calculations, and statistical power in gerontology. Innov Aging. 2019;3(4):igz036."},{"key":"b27","article-title":"Comparative Effectiveness Review Methods: Clinical Heterogeneity","author":"West SL","year":"2010","unstructured":"West SL, Gartlehner G, Mansfield AJ,  Comparative Effectiveness Review Methods: Clinical Heterogeneity. Agency for Healthcare Research and Quality (US); 2010. Accessed March 20, 2024. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53310\/"},{"issue":"2","key":"b28","series-title":"Spine J","first-page":"302","article-title":"A clinical calculator for predicting intraoperative blood loss and transfusion risk in spine tumor patients","volume":"21","author":"Pennington Z","year":"2021","unstructured":"Pennington Z, Ehresman J, Feghali J,  A clinical calculator for predicting intraoperative blood loss and transfusion risk in spine tumor patients. Spine J. 2021;21(2):302\u2013311."},{"issue":"2","key":"b29","series-title":"Plast Reconstr Surg","first-page":"507","article-title":"The role of tranexamic acid in plastic surgery: review and technical considerations","volume":"141","author":"Rohrich RJ","year":"2018","unstructured":"Rohrich RJ, Cho MJ. The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg. 2018;141(2):507\u2013515."},{"issue":"7","key":"b30","series-title":"Cochrane Database Syst Rev","first-page":"CD010562","article-title":"Topical application of tranexamic acid for the reduction of bleeding","author":"Ker K","year":"2013","unstructured":"Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev. 2013;(7):CD010562."},{"issue":"36","key":"b31","series-title":"Medicine (Baltimore)","first-page":"e4689","article-title":"Comparison of efficacy and safety of topical versus intravenous tranexamic acid in total hip arthroplasty: a meta-analysis","volume":"95","author":"Li J","year":"2016","unstructured":"Li J, Zhang Z, Chen J. Comparison of efficacy and safety of topical versus intravenous tranexamic acid in total hip arthroplasty: a meta-analysis. Medicine (Baltimore). 2016;95(36):e4689."},{"issue":"51","key":"b32","series-title":"Medicine (Baltimore)","first-page":"e5344","article-title":"Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty: a meta-analysis","volume":"95","author":"Lin C","year":"2016","unstructured":"Lin C, Qi Y, Jie L,  Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty: a meta-analysis. Medicine (Baltimore). 2016;95(51):e5344."},{"issue":"4","key":"b33","series-title":"Arch Orthop Trauma Surg","first-page":"573","article-title":"One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration","volume":"135","author":"Shemshaki H","year":"2015","unstructured":"Shemshaki H, Nourian SM, Nourian N, Dehghani M, Mokhtari M, Mazoochian F. One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg. 2015;135(4):573\u2013588."},{"issue":"11","key":"b34","series-title":"Br J Surg","first-page":"1348","article-title":"Randomized clinical trial of topical tranexamic acid after reduction mammoplasty","volume":"102","author":"Ausen K","year":"2015","unstructured":"Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg. 2015;102(11):1348\u20131353."},{"issue":"1","key":"b35","series-title":"Sci Rep","first-page":"4714","article-title":"The effect of intravenous unit-dose tranexamic acid on visible and hidden blood loss in posterior lumbar interbody fusion: a randomized clinical trial","volume":"13","author":"Hao S","year":"2023","unstructured":"Hao S, Li H, Liu 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(1):4714."},{"issue":"1","key":"b36","series-title":"Blood Coagul Fibrinolysis","first-page":"1","article-title":"What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies","volume":"30","author":"Picetti R","year":"2019","unstructured":"Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I. What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis. 2019;30(1):1\u201310."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/41\/2\/article-p224.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/41\/2\/article-p224.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/41\/2\/article-p224.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:19:58Z","timestamp":1733491198000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/41\/2\/article-p224.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":36,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2024.2.spine23779","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}