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To evaluate the efficacy of oral administration of tranexamic acid (TXA) in spine surgery to achieve blood loss reduction. Sixty patients undergoing major surgery of the spine were randomly assigned into 2 groups. Group 1 was assigned as the control group and the other group comprised patients who received oral administration of TXA 2 hours before surgery. Outcome measures included intraoperative blood loss, postoperative blood loss, hematologic parameters, blood transfusion needed, and surgical complications. Sixty patients linked up with the inclusion criteria. Intraoperative blood loss was significantly lower in the TXA oral group than in the control group; total blood loss in the TXA group was 930.66 ± 614 mL, which was lower than in the control group, with 1075.66 ± 956.11 mL. The mean reduction of hemoglobin was almost the same in both groups. Similarly, the total transfusion package received was lower, and the number of complications and length of stay were akin in both groups. A logistic regression model was performed with patients who had blood loss >1000 mL and surgery time >230 minutes. This result was related to the risk of bleeding, with an odds ratio of 1.31, 95% confidence interval, 1.004–1.023, P = 0.004, independent of the group. Oral TXA is as an effective measure for reducing total blood loss among patients undergoing elective spine surgery. [ABSTRACT FROM AUTHOR]

The role of tranexamic acid (TXA) in controlling blood loss during spine surgery remains unclear. With the publication of new randomized controlled trials (RCTs), we conducted a meta-analysis to determine the safety and efficacy of TXA in spine surgery. PubMed, Embase, Web of Science, and Cochrane databases were searched for relevant studies through 2022. Only RCTs were eligible for this study. The extracted data were analyzed using RevMan 5.3 software for meta-analysis. Twenty RCTs including 1497 patients undergoing spine surgery were included in this systematic evaluation. Compared with the control group, TXA significantly reduced total blood loss (mean difference [MD] = – 218.96, 95% confidence interval [CI] = – 309.77 to – 128.14, P < 0.00001), perioperative blood loss (MD = – 90.54, 95% CI = – 139.33 to – 41.75, P = 0.0003), postoperative drainage (MD = – 102.60, 95% CI = – 139.51 to – 65.70, P < 0.00001)，reduced hospital stay (MD = – 1.42, 95% CI = – 2.71 to – 0.14, P = 0.03), reduced total blood transfusion volume (MD = – 551.06, 95% CI = – 755.90 to – 346.22, P < 0.00001), and international normalized ratio (MD = −0.03, 95% CI = −0.04 to −0.02, P < 0.00001). Based on the meta-analysis of 20 RCTs, we demonstrated that TXA reduces blood loss in open spine surgery, decreases transfusion rates, and shortens hospital stays. The TXA administration during the perioperative period does not increase the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]