Abstract
BACKGROUND: Tranexamic acid (TXA) has shown efficacy in reducing blood loss in various surgical specialties without increasing thromboembolic risks, but its role in metastatic spinal tumor surgery (MSTS) remains unclear. This systematic review synthesized evidence on the safety and efficacy of TXA in MSTS. METHODS: PubMed, Cochrane, and Epistemonikos were searched from inception to February 1, 2025 for studies reporting on TXA use in MSTS. Study quality was assessed using the Methodological index for non-randomized studies (MINORS) tool for non-randomized studies and the the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) for randomized controlled trial (RCT). The impact of TXA on perioperative complications, blood loss, transfusion requirements, and operating time were evaluated. Meta-analysis feasibility was explored based on methodological and patient population uniformity. RESULTS: Out of a total of nine studies, 6 studies reporting on 566 patients (mean age 59 years; 45% female) met the inclusion criteria. The 5 nonrandomized studies exhibited moderate methodological quality on MINORS analysis, while the RCT demonstrated low risk of bias on RoB2 analysis. A meta-analysis was precluded due to high participant and protocol heterogeneity. TXA was not associated with increased perioperative complications, including thromboembolic events. Blood loss impact varied, with 2 studies reporting contrasting results and others finding no significant effect. Transfusion requirements showed inconsistent results across studies. TXA consistently showed no impact on operative time. CONCLUSION: There is limited evidence to draw definitive conclusions regarding the safety and efficacy of TXA in metastatic spine tumor surgery. The best available evidence suggests that the complication rate is not higher in cases involving TXA use. The benefit in decreasing blood loss was variable. High-quality research is imperative to clarify the role of TXA in this complex patient population, as well as for the establishment of refined treatment protocols.