• Yijian Zhang, Hao Liu, Fan He, Angela Chen, Huilin Yang, and Bin Pi.
• Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China; Orthopedic Institute, Soochow University, Suzhou, China.
• World Neurosurg. 2019 Jul 1; 127: 289-301.

ObjectiveTo investigate the influence of tranexamic acid (TXA) on blood loss and blood transfusion in multiple-level spine surgery and evaluate whether hemoglobin and platelet levels are altered as a result.MethodThis meta-analysis conducted an exhaustive search of literature from Pubmed, Embase, Cochrane Library, Web of Science, and CNKI databases. Stata 11.0 was used to analyze the pooled data. Mean differences (MD) of blood loss, transfusion volume, hemoglobin and platelet levels, and odds ratio (OR) of proportion of transfusion were extracted and compared between the TXA group and controls. Publication bias and sensitivity analysis were also performed.ResultA total of 11 studies (6 RCTs and 5 retrospective studies) were enrolled in this meta-analysis according to the inclusion criteria. The data showed that administration of TXA can decrease intraoperative blood loss and perioperative blood transfusion compared to controls (standard mean difference = -0.50; 95% confidence interval [CI]: -0.84, -0.16; I2 = 52.9%; P = 0.004) (OR = 0.48; 95% CI: 0.29, 0.78; I2 = 0%; P = 0.003). Moreover, TXA can maintain a superior hemoglobin level after surgery in contrast to the control group (standard mean difference = -0.27; 95% CI: 0.07, 0.47; I2 = 0%; P = 0.009). The above results were also observed and verified after accounting for publication bias and sensitivity analysis.ConclusionThe application of TXA can effectively reduce intraoperative blood loss and perioperative blood transfusion in patients undergoing multiple-level spine surgery, and it can restore hemoglobin levels after surgery.Copyright © 2019. Published by Elsevier Inc.

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