Two independent reviewers conducted electronic literature searches in 3 electronic databases (PubMed, Embase, and Cochrane library database) as well as a manual search to identify eligible clinical studies from inception to Nov 2022. Search terms used were: “Agents, Antifibrinolytic,” “Antifibrinolysin,” “Antifibrinolysins,” “Antifibrinolytics” “Antifibrinolytic,” “Antifibrinolytic Agent,” “Agent, Antifibrinolytic,” “Plasmin Inhibitors,” “Inhibitors, Plasmin,” “Antiplasmins” “Antiplasmin,” “Plasmin Inhibitor,” “Inhibitor, Plasmin, “spine surgery,” “spinal surgery,” “spine,” “lumbar surgery,” “thoracic surgery,” and “cervical surgery.” Reference lists in studies, reviews, and previous meta-analyses were checked to identify any initially omitted studies. In accordance with the abstract review, 2 investigators independently reviewed all titles, abstracts, and full texts of articles that were potentially eligible.