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Table 2 Summary of key outcomes, findings, and strength of evidence. Abbreviations: RCT, randomized controlled trial; SMD, standardized mean difference; CI, confidence interval; TXA, tranexamic acid; tTXA, topical use of TXA

From: Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis

Outcome Study design: No. studies (N) Findings and direction (magnitude) of effect Strength of evidence
Major outcomes
 Postoperative drainage output RCT: 9 (569)
Non-RCT: 3 (213)
RCTs with sufficient sample sizes and non-RCTs with low risks of study limitations found a consistent effect that tTXA reduced postoperative drainage output more than placebo, with overall SMD − 160.62 (− 302.41, − 117.83). High
 Postoperative drainage duration RCT: 3 (198)
Non-RCT: 3 (213)
RCTs and non-RCTs with medium-level study limitations found a consistent and precise effect that tTXA reduced postoperative drainage duration more than placebo, with overall SMD − 0.75 (− 1.09, − 0.40). Moderate
 Hidden blood loss RCT: 2 (141)
Non-RCT: 1 (100)
Consistent and precise effect was found in studies with medium-level study limitations that tTXA reduced perioperative hidden blood loss more than placebo by SMD − 91.18 (− 121.42, − 60.94). Moderate
 Hemoglobin level drop RCT: 3 (179)
Non-RCT: 1 (40)
Few studies included. Direction of effect in non-RCT conflicted with that in RCTs, yielding an overall SMD − 0.65 (− 1.36, 0.05) with a wide (imprecise) CI. Insufficient
Other patient-centered outcomes    
 Length of hospital stay (LOH) RCT: 7 (467)
Non-RCT: 3 (213)
Studies with medium-level study limitations yielded consistent and precise effect that tTXA reduced LOH more than placebo by SMD − 1.32 (− 1.90, − 0.74). Moderate
Adverse events
 Rod fracture Non-RCT: 1(40) Only a single event was reported in one small non-RCT. Insufficient
 Wound infection RCT: 2 (110)
Non-RCT: 1(40)
Three events were reported in a few small RCT and non-RCTs, finding no significant difference in wound infection rate. Insufficient
 Myocardial infarction RCT: 1 (29) Only a single event was reported in one small RCT. Insufficient