Studies included in the qualitative and quantitative synthesis.
| Study | Country | StudyType | SurgicalMethod | Groups | Age, y, Mean ± SD | GenderM:F | TXADosing | InclusionCriteria | ExclusionCriteria | OutcomeMeasures |
| Garg 201224 | India | Prospective,randomized | Open posteriorinstrumentation | Intervention,Control | Notmentioned | Notmentioned | 15 mg/kg bolus IV,15 min before incision | Not mentioned | Not mentioned | IBL, PBL, numberof blood transfusions,DVT incidence, and D-D |
| Hamdi 201625 | Tunisia | Prospective,randomized | Not mentioned | Intervention,Control | 48.4 ± 16.2,54.4 ± 13.7 | 17:8,15:10 | 10 mg/kg bolus IV,1 mg/kg/h IV intra-and postoperatively | Not mentioned | Not mentioned | IBL, PBL, numberof blood transfusions,DVT incidence, and D-D |
| Weera 201926 | Thailand | Prospective,randomized | Open long-segmentPSF withoutdecompression | Intervention,Control | 52 (33.5, 55.5),51.5 (33.5, 58) | 20:9,15:13 | 1 g in 20 mL salinetopical applicationvia drain, clamped for 2 h | Adults withthoracolumbar fracturesundergoing posteriorfixation surgery,no neurological deficits, ASA I, II, III | History of thromboembolic/cardiac disease, coagulationdisorder displacedlaminar fractures | Transfusion rates, PBL,drain removal time,duration of hospitalization |
| Xiji 201927 | China | Prospective,randomized,single blinded | Percutaneouspedicle screwfixation | Intervention A,Intervention B,Intervention C | 45.43 ± 8.18,45.72 ± 9.96,45.47 ± 11.24 | 34:27,37:24,33:26 | Group A: 15 mg/kg bolus IV,30 min before incision,Group B: topical 3 g insaline before wound closure,Group C: combined IV+ topical as above | Adults with single-level thoracolumbarfractures withno neurologicaldeficits undergoingsurgery within 2wk of injury | History of DVT,intake of antiplatelet/anticoagulant medications,multiple injuries | Pre- and postoperative:Hct, D-D; DVT inlower limbs, transfusionrate, complications,operative duration,IBL, TBL, HBL |
| Wentao 201928 | China | Prospective,randomized,double blinded | Open PSFwith transforaminalinterbody fusion | Intervention,Control | 41.2 ± 10.3,42.5 ± 9.5 | 25:18,18:19 | 10 mg/kg bolus IV,15 min before incision,1 mg/kg/h infusion during surgery | Adult patientswith fracture dislocationat the thoracolumbarjunction undergoingsurgery within24 h for2-level involvement | Involved segmentsabove T11 or below L2,on anticoagulation,any contraindicationto TXA use, severeinjuries, CSF leakage | Operative duration,TBL, IBL, Hb, transfusionrate, DVT incidence,levels of pre- andpostoperative GMP140, FIB, FDP, and D-D |
| Feng 202029 | China | Retrospectivecohort | PSF usingWiltse approach | Intervention A,Intervention B,Control | 42.14 ± 9.86,40.34 ± 10.28,41.06 ± 10.26 | 60:24,57:30,63:30 | Group A: 20 mg/kg TXA at 5 min beforeskin incision and 16 h after first dose; Group B received 20 mg/kg TXAat 5 min before skin incision | Adults with singlesegment fractureswithout neurologicaldeficits who underwentsurgery using theWiltse approach andother conservativelymanaged fractures | Pelvic and femoralfractures, cardiac/CNSdisease, intake of medicationthat alter hemostasis | Pre- and postoperative: Hb,FDP, D-D, FIB, Hct, LFT,PT-INR, APTT, CRP,IL-6 ; DVT in lower limbs,transfusion rate, complicationsoperative duration, IBL, TBL, HBL |
| Pradhan 201530 | Nepal | Prospective,observational | Open PSF | Intervention,Control | 39.47 ± 13.52,32.19 ± 10.71 | Notmentioned | 10 mg/kg bolus IV,30 min before incisionand 3 h postoperatively+ oral medication | Adults undergoingsingle-level PSF | 2-Level surgeries,fracture level screwfixation, iliac crest graft | Pre- and postoperative Hb,PT-INR, transfusion rates,operative duration,IBL, PBL, complications |
| Jieliang 202031 | China | Prospective,randomized,double blinded | Open PSF | Intervention,Control | 38.85 ± 4.17,39.41 ± 6.51 | 25:14,22:15 | 1 g in 100 mL salinetopical application in the woundpostmuscle dissection,kept for 5 min | Adults with single-level thoracolumbarfractures with/withoutneurological deficitsundergoing surgerywithin 24 hof injury withoutosteoporosis | Multiple comorbidities,multiple fractures,coagulopathies,CSF leakage,pathological fractures | TBL, HBL, IBL, PBL,HB, Hct, transfusion rate,length of hospital stay,operative duration |
| Abdel 202032 | Egypt | Prospective,randomized,double blinded | Open PSF | Intervention,Control | 52 (33.5, 55.5),51.5 (33.5, 58) | 7:8,4:11 | 1 g in 50 mL saline topicalapplication via drain,clamped for 2 h | Adults with thoracolumbar fractures without neurological deficits | Renal insufficiency, history of thromboembolism, history of cardiovascular diseases, coagulopathies, allergy to TXA, history of aspirin or NSAID intake 1 wk before randomization | Pre- and postoperativeHb, PBL |
| Lehman et al34 | United States | Prospective,randomized,double blinded | 3 g TXA in 70 mL saline topical solution left in wound for 5 min vs saline placebo | Adult thoracolumbar spine trauma with/without deficits undergoing surgery within 21 d; adult patients undergoing long-segment fusions (>5 fusion levels) | Coagulopathies or history of thromboembolic events; therapeutic anticoagulation requirement; use of intravenous TXA during prestudy period; trauma penetrating spinal cord or dural tears; history of seizure; traumatic brain injury | Primary outcome: maximal postoperative Hb drop, secondry outcomes: Health related quality of life, complications, cost analysis, surgical site infection, systemic absorption | ||||
| Sheng et al33 | China | Randomized controlled trial, single blinded | Group 1: intravenous TXA 10 mg/kg before incision; Group 2 topical TXA 10 mg/kg wash before wound closure; Group 3: saline placebo | Adult thoracolumbar spine trauma with no coagulopathy undergoing surgery within 2 wk | Low Hb or platelet counts or preoperative coagulopathy; has received antiplatelet/coagulant therapy; hypercoagulable states or history of thromboembolism | Primary outcome: IBL; secondary outcome: blood transfusion, PBL, Hb, PT-INR, D-D. and APTT |
Abbreviations: APTT, activated prothrombin time; CSF, cerebrospinal fluid; D-D, D-dimer; DVT, deep vein thrombosis; FDP, fibrinogrn degeneration products; FIB, fibrinogen intermediate products; Hb, hemoglobin; HBL, hidden blood loss; Hct, hematocrit; IBL, intraoperative blood loss; IV, intravenous; NSAID, non-steroidal anti-inflammatory drugs; PBL, postoperative blood loss; PE, pulmonary embolism; PSF, pedicle screw fixation; PT-INR, prothrombin time-international normalized ratio; TBL, total blood loss; TXA, tranexamic acid.