Tranexamic Acid and Major Spine Surgery: Trends and Controversies

The beneficial role and efficacy of Tranexamic Acid in reducing perioperative blood loss and blood transfusion requirements in spine surgery is being established. Tranexamic Acid is an antifibrinolytic agent traditionally used to lessen perioperative blood loss. Tranexamic Acid can be administered orally, intramuscularly, intravenously or topically. Tranexamic Acid studies in spine surgery have limited patient enrolment. Most of the reported studies have mixed results and difficult to interpret. The efficacy of antifibrinolytic agents is evident in a wide variety of surgical procedures: liver transplantation, obstetrics and gynaecology, trauma and orthopaedic surgical procedures. The effect of Tranexamic Acid on the occurrence of thromboembolic events, strokes, myocardial ischemia, seizures and mortality has not been adequately assessed and remains uncertain. A number of possible complications reported. In this review, we analyze the efficacy and safety profile of perioperative Tranexamic Acid with the exclusion of cardiac surgery and a focus on major spinal surgery.