Tranexamic Acid Versus no Tranexamic Acid in Spinal Tumor and Metastasis Surgery—Meta-Analysis

Study Design Meta-analysis. Objectives Spinal tumors and metastases remain a challenge for spine surgeons, with a significant risk of perioperative blood loss, which might require blood transfusions and lead to increased complications. Tranexamic acid (TXA) is an antifibrinolytic agent widely used in various surgical procedures; however, its efficacy in spinal oncology surgery remains unclear. This meta-analysis aims to evaluate the clinical effectiveness of TXA on perioperative outcomes, mainly blood loss, among patients with oncological spines undergoing surgery. Methods PubMed, Scopus, and Web of Science were systematically searched from inception for eligible articles. We included studies assessing TXA vs no TXA or placebo on perioperative outcomes among patients with spinal tumors or metastases. Results After a comprehensive search, seven studies were included. Blood loss (MD −111.75 mL; 95% CI −217.08 to −6.43; P = 0.04; I 2 = 83.8%), postoperative drain (MD −90.49 mL; 95% CI −150.17 to −30.81; P < 0.01; I 2 = 68.1%), hospitalization duration (MD −1.88 days; 95% CI −3.33 to −0.44; P = 0.004; I 2 = 0%), and overall complication rate (OR 0.54; 95% CI 0.34 to 0.87; P = 0.011; I 2 = 0.0) were significantly reduced in TXA group. There was no significant difference in operation time, transfusions, or thrombosis events. Conclusion Retrospective data suggest TXA may reduce blood loss in spinal tumor surgery. However, its effect on hospital stay and complications remains uncertain. Despite appearing safe, evidence remains limited by bias and heterogeneity. High-quality RCTs are needed to confirm its efficacy and define clinical guidelines.