Abstract
BackgroundThis study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery.MethodsThis 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.ResultsIn 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.ConclusionsA 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.
Highlights
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
Despite the several metaanalyses that have been done concerning the use of low dose TXA for posterior spinal fusion, there is a lack of studies of high dose TXA in adolescent idiopathic scoliosis surgery
The basic characteristics of criteria for inclusion were as follows: (1) All patients should have undergone idiopathic scoliosis surgery; (2) the study should involve preoperative intravenous administration of a high dose ≥ 50 mg/kg bolus of tranexamic acid and an intraoperative maintenance dose of TXA, which was compared with a control group; (3) all the studies should include reported outcomes of the following: total blood loss, need for blood transfusion, either allogeneic or cell salvage, and complications during the intraoperative and postoperative period
Summary
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. TXA is a synthetic antifibrinolytic that inhibits the activation of plasminogen to plasmin, thereby inhibiting binding to fibrin, which prevents fibrinolysis It can reduce bleeding during scoliosis surgery and help to prevent inflammation and platelet degradation [2], according to individual studies as well as meta-analyses, which compared the efficacy and safety of low dose TXA with a placebo. TXA was first prescribed to women with heavy menstrual blood loss and patients with hereditary bleeding disorders [3] It is used in pediatric, adult, and geriatric patients, and studies show it has been used in cardiac surgery, spine surgery, gynecological and obstetrics surgery, orthopedic surgery (knee and hip replacement), liver surgery, ENT surgery, and urological surgery [4,5,6,7,8,9]. Despite the several metaanalyses that have been done concerning the use of low dose TXA for posterior spinal fusion, there is a lack of studies of high dose TXA in adolescent idiopathic scoliosis surgery
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