Studies included in the qualitative and quantitative synthesis.
| Study | Country | Study Type | Surgical Method | Groups | Age, y, Mean ± SD | Gender M:F | TXA Dosing | Inclusion Criteria | Exclusion Criteria | Outcome Measures |
| Garg 201224 | India | Prospective, randomized | Open posterior instrumentation | Intervention, Control | Not mentioned | Not mentioned | 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-segment PSF without decompression | Intervention, Control | 52 (33.5, 55.5), 51.5 (33.5, 58) | 20:9, 15:13 | 1 g in 20 mL saline topical application via drain, clamped for 2 h | Adults with thoracolumbar fractures undergoing posterior fixation surgery, no neurological deficits, ASA I, II, III | History of thromboembolic/cardiac disease, coagulation disorder displaced laminar fractures | Transfusion rates, PBL, drain removal time, duration of hospitalization |
| Xiji 201927 | China | Prospective, randomized, single blinded | Percutaneous pedicle screw fixation | 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 thoracolumbar fractures withno neurological deficits 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 PSF with transforaminal interbody 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 patients with fracture dislocation at the thoracolumbar junction undergoing surgery within 24 h for 2-level involvement | Involved segments above T11 or below L2, on anticoagulation, any contraindication to TXA use, severeinjuries, CSF leakage | Operative duration, TBL, IBL, Hb, transfusionrate, DVT incidence, levels of pre- andpostoperative GMP 140, FIB, FDP, and D-D |
| Feng 202029 | China | Retrospective cohort | PSF using Wiltse 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 before skin incision and 16 h after first dose; Group B received 20 mg/kg TXAat 5 min before skin incision | Adults with single segment fractures without neurological deficits who underwent surgery using the Wiltse approach and other conservatively managed fractures | Pelvic and femoral fractures, cardiac/CNS disease, intake of medication that alter hemostasis | Pre- and postoperative: Hb, FDP, D-D, FIB, Hct, LFT, PT-INR, APTT, CRP, IL-6; DVT in lower limbs, transfusion rate, complications operative 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 incision and 3 h postoperatively + oral medication | Adults undergoing single-level PSF | 2-Level surgeries, fracture level screw fixation, 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 saline topical application in the wound postmuscle dissection, kept for 5 min | Adults with single-level thoracolumbar fractures with/without neurological deficits undergoing surgery within 24 hof injury without osteoporosis | 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 topical application 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 |
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.