Studies were included in this review if they met all the following Population/Intervention/Comparison/Outcome(s) (PICOS) criteria: (P) The study included spinal surgeries of all types (lumbar, thoracic, thoracolumbar, and cervical) used either anteriorly or posteriorly. (I) antifibrinolytics (AP, TXA, or EACA); (C) Placebo; (O) Total blood loss, transfusion rate and the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE); (S) randomized controlled trials (RCTs). Exclusion criteria were as follows: case control study, cohort study and retrospective study; duplicate publications; relevant specific data cannot be obtained; comments, letters, and guidelines; study did not report outcomes of interest.