Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Is tranexamic acid effective in reducing postoperative blood loss in adult patients with lumbar degenerative disease who are undergoing posterior lumbar spinal fusion surgery?”

STUDY DESIGN: A review of two double-blinded randomized controlled trials (RCT) and one RCT.

DATA SOURCES: All articles were peer-reviewed and published in English between 2017-2020. They were found through PubMed and chosen based on ability to answer the objective.

OUTCOMES MEASURED: The outcome measured in all articles was the objective amount of blood loss in mL contained in drainage output through postoperative day two. Xu et al. 2020 and Xu et al. 2017 calculated the pure blood contained in the postoperative drainage, while Kim et al. considered all fluid in the postoperative drainage to represent blood loss.

RESULTS: Xu et al. 2020 found a statistically significant difference (p-value <0.05) between the tranexamic acid (TXA) group, whose mean blood loss represented as mean ± standard deviation was 55.0± 23, and the placebo group, whose blood loss was reported as 114.5± 45.9. There was a mean difference of 59.5 between the groups. The study performed by Xu et al. 2017 found that average blood loss was 39.9± 28.5 in the TXA group, and 160.2± 82.8 in the placebo group, with a statistically significant p-value of 0.001. The mean difference between groups was 120.3. Kim et al. reported a mean 24-hour postoperative blood loss of 384± 33 in the TXA group, and 541± 28 in the placebo group, with a p-value of 0.04 and a mean difference of 157. Blood loss upon drain removal in the TXA group was 149± 18 and was 274± 50 in the placebo group, with a p-value of 0.02 and a mean difference of 125.

CONCLUSION: All studies in this review found that use of TXA in posterior lumbar interbody fusion (PLIF) was effective in decreasing postoperative blood loss in patients with severe lumbar degenerative disease. Future studies could focus on optimal dosing and route of TXA administration.