Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Abstract

Objective. To evaluate the efficacy and safety of different dose regimens of intravenous (IV) tranexamic acid (TXA) in adolescent spinal deformity surgery. Methods. Two researchers independently searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science to find studies that met the inclusion criteria. A meta-analysis was performed based on the guidelines of the Cochrane Reviewer’s Handbook. Results. Six randomized controlled trials (RCTs) and eleven non-RCTs were identified, including 1148 patients. According to different dose regimens of IV TXA, the included studies were divided into the high-dose group and the low-dose group. Compared with placebo, both groups had less total blood loss (TBL) (high dose: WMD = − 1737.55 , 95% CI: (-2247.16, -1227.94), P < 0.001 , I 2 = 0 % ; low dose: WMD = − 528.67 , 95% CI: (-666.06, -391.28), P < 0.001 , I 2 = 0 % ), intraoperative blood loss (IBL) (high dose: WMD = − 301.48 , 95% CI: (-524.3, -78.66), P = 0.008 , I 2 = 60.3 % ; low dose: WMD = − 751.14 , 95% CI: (-967.21, -535.08), P < 0.001 , I 2 = 0 % ), and blood transfusion rates (high dose: RR = 0.19 , 95% CI: (0.1, 0.37), P < 0.001 , I 2 = 0 % ; low dose: RR = 0.4 , 95% CI: (0.18, 0.91), P = 0.029 , I 2 = 57 % ). High-dose IV TXA use was associated with more vertebral fusion segments ( WMD = 0.53 , 95% CI: (0.23, 0.82), P < 0.001 , I 2 = 31.2 % ). Low-dose IV TXA use was associated with shorter operative time ( WMD = − 18.43 , 95% CI: (-26.68, -10.17), P < 0.001 , I 2 = 0 % ). Conclusion. High-dose and low-dose IV TXA were effective in reducing TBL, IBL, and blood transfusion rates without increasing complications in adolescent patients undergoing spinal deformity surgery. Low-dose IV TXA was effective in reducing the operative time. Both the high-dose and low-dose groups had similar preoperative and postoperative Hb levels compared to the control group.

Evaluation of the Efficacy of Stem Cell Therapy in Ovariectomized Osteoporotic Rats Based on Micro-CT and Dual-Energy X-Ray Absorptiometry: A Systematic Review and Meta-Analysis

“…Publication Bias. Publication bias is now commonly assessed in meta-analysis using Begg's funnel plot and Egger's test and is usually performed in at least 10 studies [24]. Because of the high heterogeneity in the results of the above pooled analysis, we performed an assessment of publication bias.…”

“…Sensitivity Analysis. Sensitivity analysis is also usually performed in a meta-analysis to assess the stability of the results of the pooled literature analysis [24]. We used a sensitivity analysis by removing all the included literature for all outcome measurements one by one and also used STATA software to plot the sensitivity analysis figures (Figure 10).…”

“…Each element could be judged as one of high risk of bias, low risk of bias, or unclear risk of bias based on the actual content of the study. The Newcastle-Ottawa Scale (NOS) containing three main items (selection, comparability, and outcome) can be used to assess the quality of the included non-RCTs [24]. This scale is also subdivided into eight detailed quality items (selection: 4 quality items; comparability: 1 quality item; outcome: 3 quality items).…”

Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis

“…[2] Tranexamic acid (TXA), an anti-fibrinolytic, has successfully been in use as a pharmacological intervention to decrease blood loss volume (BLV) throughout surgery when administered either through IV or topically. [2,[8][9][10][11][12] In a large scale review of TXA use in multilevel spine surgery including 23 studies and 1621 patients, Zhao et al found that TXA significantly reduced both intraoperative BLV (Weighed Mean Difference [WMD]: -215.7 ml; 95% Confidence Interval [CI]: -307.5, -123.8) and total BLV (WMD: -284.4 ml; 95% CI: -437.7, -131.1) [13] when compared to placebo; however, they did not investigate different dosing strategies. The optimal dosing regimen of IV TXA in adult spinal surgeries is still under investigation, with loading doses (LD) ranging from 1.5-15 mg/kg [14,15] and maintenance doses (MD) ranging 1-2 mg/kg/hour, [16,17] if a maintenance dose is used at all.…”

“…The optimal dosing regimen of IV TXA in adult spinal surgeries is still under investigation, with loading doses (LD) ranging from 1.5-15 mg/kg [14,15] and maintenance doses (MD) ranging 1-2 mg/kg/hour, [16,17] if a maintenance dose is used at all. [18] Other high dose regimens may involve a single TXA bolus of >1 g. [11] All dosing regimens have been reported to effectively control blood loss and reduce postoperative need for transfusion. [19] With approximately 1.62 million instrumented spinal procedures occurring annually in the United States, and a projected global market increase to $18 billion by 2023, [20] there is a need for further study into optimal methods of decreasing perioperative blood loss and associated healthcare costs.…”