The Perioperative Efficacy and Safety of Tranexamic Acid in Adolescent Idiopathic Scoliosis

Abstract

To evaluate the efficacy and safety of tranexamic acid (TXA) in patients with adolescent idiopathic scoliosis undergoing corrective surgery. A literature search of PubMed, Embase, and Cochrane Library was performed to identify studies published from inception to February 2019. After study selection and data extraction, statistical analysis was performed. Odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (CIs) for all available clinical outcomes were analyzed using fixed-effects or random-effects models. Twelve studies comprising 2500 patients were included. Intravenous TXA use was associated with significantly fewer patients received blood transfusions (odds ratio, 0.12; 95% CI, 0.06 to 0.22; P < 0.001), less intraoperative estimated blood loss (WMD,-470.07; 95% CI,-645.23 to-294.90; P < 0.001), less intraoperative estimated blood loss per segment (WMD,-27.40; 95% CI,-32.80 to-22.00; P < 0.001), less cell salvage blood transfusion (WMD,-106.02; 95% CI,-170.84 to-41.20; P= 0.001), and shorter surgical time (WMD,-26.18; 95% CI,-46.91 to-5.46; P= 0.010). No significant difference was found in postoperative hemoglobin (WMD, 0.39; 95% CI,-0.07 to 0.86; P= 0.100) and hemoglobin change (WMD,-0.92; 95% CI,-2.90 to 1.07; P= 0.360) between TXA and control groups. No renal, thromboembolic, or other major complications associated with TXA were noted in included studies. TXA was effective in reducing surgical time, intraoperative estimated blood loss, and blood transfusion without increasing complications in patients undergoing corrective surgery for adolescent idiopathic scoliosis. TXA had no influence on postoperative hemoglobin and hemoglobin change.