Comparative Effectiveness of Intravenous, Oral, and Topical Tranexamic Acid in Elective Spine Surgery: A Systematic Review and Network Meta-Analysis.
6 affiliations
- 1Al-Balqa' Applied University, Salt, Jordan.
- 2Georgetown University Medical Center, Washington, DC, USA.
- 3The University of Jordan, Amman, Jordan.
- 4Jordan University of Science and Technology, Irbid, Jordan.
- 5Tishreen University, Latakia, Syrian Arab Republic.
- 6Department of Neurosurgery, King Hussein Cancer Center, Amman, Jordan.
Abstract
Study DesignSystematic review and Bayesian network meta-analysis.ObjectiveTo compare the efficacy and safety of intravenous (IV), oral, topical, and combined IV+topical tranexamic acid (TXA) in reducing perioperative bleeding and transfusion requirements in elective spine surgery, and to identify the optimal administration route.MethodsWe searched Ovid MEDLINE, Ovid Embase, and CENTRAL from inception to February 20, 2026, for RCTs evaluating TXA routes in elective spine procedures. A Bayesian random-effects network meta-analysis was performed. Primary outcomes were length of stay (LOS), blood loss, and drainage volume; secondary outcomes included hemoglobin levels, operative time, complications, transfusion requirements, and coagulation parameters. Treatment rankings were estimated using Surface Under the Cumulative Ranking Curve (SUCRA). Trial sequential analysis (TSA) assessed evidence robustness.ResultsTwenty-five randomized controlled trials were included. Combined IV+topical TXA ranked highest for reducing LOS (SUCRA 97.1%; mean difference -2.46 days vs. control, 95% CrI -4.15 to -0.81), intraoperative blood loss (SUCRA 83.9%; MD -122.8 mL, 95% CrI -202.2 to -43.6), postoperative day 1 hemoglobin preservation (SUCRA 96.5%; MD +0.99 g/dL, 95% CrI 0.43-1.57), and drainage volume (SUCRA 83.4%; MD -191.3 mL, 95% CrI -311.6 to -74.8). Oral TXA ranked first for total blood loss (SUCRA 83.8%; MD -421.2 mL, 95% CrI -691.9 to -156.6), closely followed by combined IV+topical TXA (SUCRA 82.2%). No route significantly increased complications or adversely affected coagulation. TSA suggested insufficient evidence for definitive conclusions on several outcomes.ConclusionsCombined IV+topical TXA ranked highest for reducing hospital stay, intraoperative blood loss, and drainage volume in elective spine surgery, and no route was associated with a detected increase in reported complications. These findings suggest that combined IV+topical TXA is a promising option; however, TSA indicated that the available evidence is insufficient to establish definitive route superiority or safety, and further high-quality trials are needed.
Related
- Pilot Study of Combined Tranexamic Acid Therapy in Breast Reduction – Intravenous and Local Infiltration
- Comparative Effectiveness of Tricyclic Antidepressants, Serotonin–Norepinephrine Reuptake Inhibitors, and Anticonvulsants for Diabetic Painful Neuropathy: A Systematic Review and Meta-Analysis
- Comparative effectiveness of acupuncture combined with rehabilitation for post-stroke hemiplegia: a systematic review and network meta-analysis
- Comparative effectiveness of exercise and self-management interventions delivered through different modes of digital support on pain and patient-reported physical function in people with knee osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials
- Comparative Effectiveness and Safety of Rebamipide Versus Diquafosol in the Treatment of Dry Eye Disease: A Systematic Review and Meta-Analysis.
BibTeX
@article{hammadeh2026comparative,
title = {{Comparative Effectiveness of Intravenous, Oral, and Topical Tranexamic Acid in Elective Spine Surgery: A Systematic Review and Network Meta-Analysis.}},
author = {Bara M Hammadeh and Cameron J Sabet and Ahmad Al-Qunbar and Leen Sabbah and AlBaraa K Mohammad and Zaid Hasan and Abdulhalim Kikhia and Mohammad Khalil Al-Barbarawi},
journal = {Global spine journal},
year = {2026},
month = oct,
doi = {10.1177/21925682261503531},
url = {https://europepmc.org/article/MED/42954965},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparative Effectiveness of Intravenous, Oral, and Topical Tranexamic Acid in Elective Spine Surgery: A Systematic Review and Network Meta-Analysis.
AU - Bara M Hammadeh
AU - Cameron J Sabet
AU - Ahmad Al-Qunbar
AU - Leen Sabbah
AU - AlBaraa K Mohammad
AU - Zaid Hasan
AU - Abdulhalim Kikhia
AU - Mohammad Khalil Al-Barbarawi
PY - 2026
DA - 2026/10/29
JO - Global spine journal
DO - 10.1177/21925682261503531
UR - https://europepmc.org/article/MED/42954965
AB - Study DesignSystematic review and Bayesian network meta-analysis.ObjectiveTo compare the efficacy and safety of intravenous (IV), oral, topical, and combined IV+topical tranexamic acid (TXA) in reducing perioperative bleeding and transfusion requirements in elective spine surgery, and to identify the optimal administration route.MethodsWe searched Ovid MEDLINE, Ovid Embase, and CENTRAL from inception to February 20, 2026, for RCTs evaluating TXA routes in elective spine procedures. A Bayesian random-effects network meta-analysis was performed. Primary outcomes were length of stay (LOS), blood loss, and drainage volume; secondary outcomes included hemoglobin levels, operative time, complications, transfusion requirements, and coagulation parameters. Treatment rankings were estimated using Surface Under the Cumulative Ranking Curve (SUCRA). Trial sequential analysis (TSA) assessed evidence robustness.ResultsTwenty-five randomized controlled trials were included. Combined IV+topical TXA ranked highest for reducing LOS (SUCRA 97.1%; mean difference -2.46 days vs. control, 95% CrI -4.15 to -0.81), intraoperative blood loss (SUCRA 83.9%; MD -122.8 mL, 95% CrI -202.2 to -43.6), postoperative day 1 hemoglobin preservation (SUCRA 96.5%; MD +0.99 g/dL, 95% CrI 0.43-1.57), and drainage volume (SUCRA 83.4%; MD -191.3 mL, 95% CrI -311.6 to -74.8). Oral TXA ranked first for total blood loss (SUCRA 83.8%; MD -421.2 mL, 95% CrI -691.9 to -156.6), closely followed by combined IV+topical TXA (SUCRA 82.2%). No route significantly increased complications or adversely affected coagulation. TSA suggested insufficient evidence for definitive conclusions on several outcomes.ConclusionsCombined IV+topical TXA ranked highest for reducing hospital stay, intraoperative blood loss, and drainage volume in elective spine surgery, and no route was associated with a detected increase in reported complications. These findings suggest that combined IV+topical TXA is a promising option; however, TSA indicated that the available evidence is insufficient to establish definitive route superiority or safety, and further high-quality trials are needed.
SN - 2192-5682
SN - 2192-5690
ER -