TY - JOUR
T1 - Antifibrinolytic agents for paediatric scoliosis surgery
T2 - a systematic review and meta-analysis
AU - Karimi, Shoahaib
AU - Lu, Victor M.
AU - Nambiar, Mithun
AU - Phan, Kevin
AU - Ambikaipalan, Anuruthran
AU - Mobbs, Ralph J.
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Study design: Systematic review and meta-analysis of randomised controlled trials. Objective: The purpose of this study is to perform a systematic review and meta-analysis of antifibrinolytic agents for paediatric spine surgery. Background: Bleeding is an important consideration in paediatric scoliosis surgery; blood loss leads directly to higher morbidity and mortality. Antifibrinolytics are an attractive non-invasive method of reducing bleeding as evidenced in arthroplasty, cardiac surgery and adult scoliosis surgery. Methods: A thorough database search of Medline, PubMed, EMBASE and Cochrane was performed according to PRISMA guidelines, and a systematic review was performed. Results: Five randomised controlled trials were identified in this meta-analysis, consisting of a total of 285 spine surgery patients with subgroups of tranexamic acid (n = 101), epsilon aminocaproic acid (n = 61) and control (n = 123). This meta-analysis found that antifibrinolytics lead to statistically significant reductions in peri-operative blood loss (MD − 379.16, 95% CI [− 579.76, − 178.57], p < 0.001), intra-operative blood loss (MD − 516.42, 95% CI [− 1055.58, 22.74], p < 0.001), reduced fresh frozen plasma requirements (MD − 307.77, 95% CI [− 369.66, − 245.88], p < 0.001) and reduced post-operative blood loss (MD − 185.95, 95% CI [− 336.04, − 35.87], p = 0.02). Conclusion: This meta-analysis concludes that antifibrinolytics lead to statistically significant reductions in peri-operative blood loss, intra-operative blood loss, reduced fresh frozen plasma requirements and reduced post-operative blood loss with TXA. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
AB - Study design: Systematic review and meta-analysis of randomised controlled trials. Objective: The purpose of this study is to perform a systematic review and meta-analysis of antifibrinolytic agents for paediatric spine surgery. Background: Bleeding is an important consideration in paediatric scoliosis surgery; blood loss leads directly to higher morbidity and mortality. Antifibrinolytics are an attractive non-invasive method of reducing bleeding as evidenced in arthroplasty, cardiac surgery and adult scoliosis surgery. Methods: A thorough database search of Medline, PubMed, EMBASE and Cochrane was performed according to PRISMA guidelines, and a systematic review was performed. Results: Five randomised controlled trials were identified in this meta-analysis, consisting of a total of 285 spine surgery patients with subgroups of tranexamic acid (n = 101), epsilon aminocaproic acid (n = 61) and control (n = 123). This meta-analysis found that antifibrinolytics lead to statistically significant reductions in peri-operative blood loss (MD − 379.16, 95% CI [− 579.76, − 178.57], p < 0.001), intra-operative blood loss (MD − 516.42, 95% CI [− 1055.58, 22.74], p < 0.001), reduced fresh frozen plasma requirements (MD − 307.77, 95% CI [− 369.66, − 245.88], p < 0.001) and reduced post-operative blood loss (MD − 185.95, 95% CI [− 336.04, − 35.87], p = 0.02). Conclusion: This meta-analysis concludes that antifibrinolytics lead to statistically significant reductions in peri-operative blood loss, intra-operative blood loss, reduced fresh frozen plasma requirements and reduced post-operative blood loss with TXA. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
KW - Antifibrinolytic agents
KW - Epsilon aminocaproic acid
KW - Paediatric spine surgery
KW - Tranexamic acid
UR - http://www.scopus.com/inward/record.url?scp=85061304271&partnerID=8YFLogxK
U2 - 10.1007/s00586-019-05911-8
DO - 10.1007/s00586-019-05911-8
M3 - Review Article
C2 - 30739188
AN - SCOPUS:85061304271
SN - 0940-6719
VL - 28
SP - 1023
EP - 1034
JO - European Spine Journal
JF - European Spine Journal
IS - 5
ER -