Antifibrinolytic agents for paediatric scoliosis surgery: a systematic review and meta-analysis

Shoahaib Karimi, Victor M. Lu, Mithun Nambiar, Kevin Phan, Anuruthran Ambikaipalan, Ralph J. Mobbs

Research output: Contribution to journalReview ArticleResearchpeer-review

20 Citations (Scopus)

Abstract

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.].

Original languageEnglish
Pages (from-to)1023-1034
Number of pages12
JournalEuropean Spine Journal
Volume28
Issue number5
DOIs
Publication statusPublished - 1 May 2019
Externally publishedYes

Keywords

  • Antifibrinolytic agents
  • Epsilon aminocaproic acid
  • Paediatric spine surgery
  • Tranexamic acid

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