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Meta-Analysis
. 2021 Jan 14;16(1):53.
doi: 10.1186/s13018-020-02158-8.

The efficacy and safety of high-dose tranexamic acid in adolescent idiopathic scoliosis: a meta-analysis

Indra K Shrestha  1 , Tian-Yi Ruan  1 , Lan Lin  1 , Miao Tan  1 , Xue-Qing Na  1 , Qi-Cai Qu  1 , Jian-Chun Chen  1 , Yong-Yu Si  2 , Jian-Ping Tao  3
Affiliations
Meta-Analysis

The efficacy and safety of high-dose tranexamic acid in adolescent idiopathic scoliosis: a meta-analysis

Indra K Shrestha et al. J Orthop Surg Res. .

Abstract

Background: 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.

Methods: This 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.

Results: In 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.

Conclusions: A 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.

Keywords: Blood loss; Posterior spinal fusion; Scoliosis surgery; Thromboembolic event; Tranexamic acid.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Method of selection for inclusion in the study
Fig. 2
Fig. 2
Bias risk assessments for each RCT study (“+” indicates present or yes, and “blank” indicates unclear)
Fig. 3
Fig. 3
Forest plot of the effect of TXA on estimated blood loss
Fig. 4
Fig. 4
Sensitivity analysis of blood loss
Fig. 5
Fig. 5
Forest plot of operative time
Fig. 6
Fig. 6
Sensitivity analysis of operative time
See this image and copyright information in PMC

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