Hemostatic agents in spine surgery: A critical analysis review

«Hemostatic agents are widely utilized in spine surgery to reduce blood loss and the need for allogenic blood transfusions. » Several hemostatic agents are available for the spine surgeon and can be categorized as active agents (via activation of the coagulation cascade) and passive agents (via contact activation and promotion of platelet activation). « Intravenous administration of tranexamic acid has been consistently demonstrated in numerous clinical trials to reduce blood loss in spine surgery. » Several case reports and case series have suggested that the use of hemostatic agents may cause adverse events in the perioperative period. Understanding these associated adverse events and the means of avoiding them may greatly improve patient safety. There is insufficient and inconclusive evidence to advocate for or against the use of many of the available hemostatic agents. In turn, there is a need for more clinical trials evaluating the effectiveness and safety of hemostatic agents in spine surgery.