The efficacy and safety of high-dose tranexamic acid in adolescent idiopathic scoliosis: a meta-analysis

Abstract

Background This study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery. Methods This study was a meta-analysis, which consisted of retrospective cohort studies (RCSs) and randomized control trials (RCTs) found by searching electronic databases, namely PubMed, Web of Science, The Cochrane Central Register of Controlled Trials (CENTRAL), and the Google Scholar Database, dating from 1960 to 2019. The points of interest included total blood loss, a need for transfusion and transfusion criteria, surgery time, and the evidence of intraoperative and postoperative complications, such as seizures or thromboembolic events. The weighted mean differences (WMD) and 95% confidence interval (CI) of blood loss in the TXA intervention group compared to the control or placebo group were extracted and combined using the random effects model. Results In this meta-analysis, there was a total of three RCSs and two RCTs, which involved 334 patients. The results showed that blood loss is significantly reduced, with a weighted mean difference in the TXA group (WMD = − 525.14, P = 0.0000, CI ranged from − 839.83, − 210.44, I2 = 82%). Heterogeneity was assessed using the random effects model. Conclusions A high dose of intravenous TXA reduced blood loss during adolescent idiopathic scoliosis surgery and did not lead to any significant thromboembolic event. Therefore, a high dose appears to be effective and safe for adolescent idiopathic scoliosis surgery. However, more high-quality research based on larger randomized controlled trials is still needed.

High- versus low-dose tranexamic acid as part of a Patient Blood Management strategy for reducing blood loss in patients undergoing surgery for adolescent idiopathic scoliosis

“…The optimal dosing regimen of TXA in surgery for AIS has yet to be defined. A recent meta-analysis of 334 patients with AIS showed that a high dose TXA regimen (loading dose of 50–100 mg/kg, maintenance infusion of 10–30mg/kg/hr) significantly reduced blood loss when compared to placebo and did not lead to any significant thromboembolic events [ 6 ].…”

Scoliotic deformity of the spine: epidemiology, classification, surgical treatment, prediction and correction of intraoperative blood loss

“…Связанное с переливанием острое повреждение легких (TRALI) может возникнуть во время или после переливания и остается основной причиной заболеваемости и смертности, связанных с переливанием крови [25]. Исходя из вышесказанного, важно минимизировать интраоперационную кровопотерю, что, в свою очередь, снижает риск переливания крови [17].…”

“…Одним из спорных вопросов при идиопатическом сколиозе, не подвергаю щемуся коррекции, является влияние размера искривления на дыхательную функцию. В то время как пациенты с искривлением от 90° до 100° считаются подверженными риску кардиореспираторной недостаточности в более позднем возрасте, нарушение искривления ниже 90° обычно считается легким [17].…”

Blood Loss and Transfusion in a Pediatric Scoliosis Surgery Cohort in the Antifibrinolytic Era

“…[13][14][15][16][17] Efforts are ongoing to determine the optimal dosing regimen, duration of therapy, and relative efficacy of TXA versus EACA in pediatric scoliosis surgery. 13,[17][18][19][20] The primary goal of this single-center retrospective study was to describe blood loss and transfusion rates in a pediatric scoliosis cohort and to compare these outcomes in patients receiving TXA versus EACA. An important secondary goal was to evaluate if antifibrinolytic choice and preoperative hematologic laboratory parameters were predictive of blood loss and transfusion, as this knowledge could be useful in guiding future optimal antifibrinolytic regimens, understanding the mechanisms of surgical-induced coagulopathy, informing perioperative optimization efforts, and improving outcomes for children with scoliosis.…”

“…Antifibrinolytics reduce intraoperative blood loss and transfusion burden in scoliosis surgery,13 and their efficacy has now been well documented in a variety of surgical settings 13–17. Efforts are ongoing to determine the optimal dosing regimen, duration of therapy, and relative efficacy of TXA versus EACA in pediatric scoliosis surgery 13,17–20…”