The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

Zhang, Zhuang; Wang, Linnan; Yang, Xi; Liu, Limin; Peng, Xiaoyan; Zhou, Zhongjie; Wang, Lei; Song, Yueming

doi:10.1016/j.spinee.2020.10.011

Cited by 20 publications

(49 citation statements)

References 37 publications

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“…19,[47][48][49][50] The majority of included studies were RCTs, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40]43,44,[46][47][48][49][50] while five were cohort studies including a control group. 19,34,41,42,45 The participants in most of the articles were undergoing elective surgery (n ¼ 3,563) 19-39,41--47,49,50 of which 13 studies investigated total knee arthroplasty patients which, at least partly, is an inflammatory condition (n ¼ 1,918), 20,22,24,25,27,34,35,[37][38][39]42,...…”

Section: Resultsmentioning

confidence: 99%

“…[21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Finally, five studies examined the difference of the inflammatory effect of TXA between different administration forms of TXA. 21,27,31,35,45 Inflammatory Biomarkers ►Table 1 shows a summary of the 14 included studies that investigated inflammatory markers in TXA patients and compared them to either a group receiving placebo or no medication, [19][20][21]25,26,29,30,32,34,36,40,42,[48][49][50] while ►Table 2 presents a summary of 14 articles that investigated inflammatory biomarkers in surgical patients receiving TXA and compared them to a single group or several groups receiving either fewer or lower doses of TXA. [21][22][23][24]28,33,[37][38][39]41,43,44,46,...…”

Section: Resultsmentioning

confidence: 99%

“…[21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Interleukin-6 (IL-6) was investigated in 22 studies resulting in nine good rated studies [20][21][22][23][24][25][26]28,29 and in 13 fair or poor rated studies. 19,30,[32][33][34][37][38][39]41,43,44,49,50 Most of the studies rated good found a significantly decreased level of IL-6 postoperatively among TXA patients when compared with a control group [20][21][22][23][24][25]29 as did most of the studies rated fair or poor. 19,[37][38][39]41,43,…”

Section: Resultsmentioning

confidence: 99%

“…19,[37][38][39]41,43,44,49,50 However, two studies, rated good, did not find a significant difference in IL-6 between TXA patients and controls 26,28 supported by three studies rated fair, 30,32,33 and one fair rated study even showed higher IL-6 levels among TXA patients than in controls. 34 Fifteen studies [20][21][22][23][24][25]29,37,39,[41][42][43][44]47,48 investigated C-reactive protein (CRP), among which seven studies rated good. [20][21][22][23][24][25]29 All good rated studies showed lower postoperative CRP levels among TXA patients than in controls.…”

Section: Resultsmentioning

confidence: 99%

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Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Okholm

Krog

Hvas

2022

Semin Thromb Hemost

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Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for reducing blood loss in patients with major bleedings. Animal and cell studies have shown that TXA might modulate the inflammatory response by either enhancing or inhibiting cytokine levels. Furthermore, recent human studies have found altered inflammatory biomarkers in patients receiving TXA when compared with patients who did not receive TXA. In this systematic review we investigated the effect of TXA on inflammatory biomarkers in different patient groups. A systematic literature search was conducted on the databases PubMed and Embase to identify all original articles that investigated inflammatory biomarkers in patients receiving TXA and compared them to a relevant control group. The review was performed according to the PRISMA guidelines, and the literature search was performed on November 29, 2021. Thirty-three studies were included, among which 14 studies compared patients receiving TXA with patients getting no medication, another 14 studies investigated different dosing regimens of TXA, and finally five studies examined the administration form of TXA. The present review suggests that TXA has an anti-inflammatory effect in patients undergoing orthopaedic surgery illustrated by decreased levels of C-reactive protein and interleukin-6 in patients receiving TXA compared with patients receiving no or lower doses of TXA. However, the anti-inflammatory effect was not found in patients undergoing cardiac surgery, pediatric craniosynostosis patients, or in rheumatoid arthritis patients. The inflammatory response was not affected by administration form of TXA (oral, intravenous, or topical). In conclusion, an anti-inflammatory effect of TXA was consistently found among orthopaedic patients only.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Okholm

Krog

Hvas

2022

Semin Thromb Hemost

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“…16,17 A few smaller studies, with sample sizes ranging from 44 to 166 patients, reported on the safety of TXA use in this population and did not nd any associated adverse events. [18][19][20][21][22][23][24][25] However, concerns remain that rare, yet serious side effects, may not be adequately captured in a small sample.…”

Section: Introductionmentioning

confidence: 99%

Safety Of Tranexamic Acid Use In Pediatric Patients Undergoing Spinal Fusion Surgery: A Retrospective Comparative Cohort Study

Ivasyk

Chatterjee

Jordan

et al. 2022

Preprint

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Background: Pediatric spinal fusion may be associated with significant intraoperative blood loss, leading to complications from transfusion, hypoperfusion and coagulopathy. One emerging strategy to mediate these risks is by utilization of the anti-fibrinolytic agent tranexamic acid (TXA). However, concerns regarding potential adverse reactions, specifically postoperative seizures and thrombotic events, still exist. To assess these risks, we examined the perioperative morbidity of TXA use in a large national database. Methods: Retrospective data from pediatric patients (age 18 years or younger), discharged between January 2013 to December 2015, who underwent primary or revision posterior spinal fusions, was collected from the Premier Perspective database (Premier, Charlotte, NC). Patients were stratified by TXA use and records were assessed for complications of new onset seizures, strokes, pulmonary embolisms (PE) or deep vein thromboses (DVT) occurring during the perioperative period. Results: In this cohort of 2,633 pediatric patients undergoing posterior spinal fusions, most often to treat adolescent idiopathic scoliosis, 15% received TXA. Overall, adverse events were rare in this patient population. The incidence of seizure, stoke, PE, or DVT in the control group was 0.54% (95% CI, 0.31% to 0.94%) and not significantly different from the TXA group. There was no significant difference in the incidence of DVTs, and no incidences of stroke in either group. There were no new-onset seizures or PEs in patients who received TXA. Conclusions: The use of TXA was not associated with an increased risk of adverse events including seizure, stroke, PE, and DVT. Our findings support the safety of TXA use in pediatric patients undergoing spinal fusion surgery.

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Predicting delayed extubation and transfer to the intensive care unit in children undergoing posterior fusion surgery for scoliosis

Wang,

Xia,

et al. 2024

Anaesthesiologie

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The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

Cited by 20 publications

References 37 publications

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Safety Of Tranexamic Acid Use In Pediatric Patients Undergoing Spinal Fusion Surgery: A Retrospective Comparative Cohort Study

Predicting delayed extubation and transfer to the intensive care unit in children undergoing posterior fusion surgery for scoliosis

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