Tranexamic acid can reduce blood loss in adolescent scoliosis surgery: a systematic review and meta-analysis

Abstract

Background: Tranexamic acid (TXA) has been widely used in orthopedic surgery, but its efficacy in adolescent scoliosis (AS) surgery remains unclear in the literature. The purpose of this systematic review and meta-analysis is to evaluate the safety and efficacy of TXA compared to placebo treatment during or after AS surgery, by gathering data from randomized both controlled trials (RCTs) and non-RCTs.

Methods: English and Chinese electronic databases including PubMed, Web of Science, Embase, Cochrane, CNKI, and Wan Fang database were searched to identify the relevant literature up until August 2022. The primary outcomes were intraoperative blood loss and total blood loss. The secondary outcomes included the need for transfusion, postoperative hemoglobin (Hb) level, and change in Hb level. Stata 17 was used for data analysis and the risk of bias was assessed. We followed the PRISMA checklist to ensure the quality of this article.

Results: Twelve studies (795 participants) were included in the meta-analysis for intraoperative blood loss during surgery. The results suggest that TXA can reduce the intraoperative blood loss of the patients (MD = -306.40ml, 95%CI = -404.04ml to -208.77ml, p < 0.001). Six studies (2027 patients) were included in the meta-analysis for total blood loss. The pooled result shows that the total blood loss of the TXA group was significantly lower than that of the control group (MD = -779.24ml, 95% CI = -1157.10ml to -410.39ml, p < 0.001). Five studies (419 patients) were included in the meta-analysis for postoperative Hb level and shows a non-significant outcome (MD = 5.09 g/l, 95%CI = 2.92 g/l to 7.25 g/l, p = 0.611). Three studies (268 patients) were included in the meta-analysis for the postoperative Hb level. There is a non-significant decrease in the TXA group (MD = -0.23 g/l, 95%CI = -0.48 g/l to 0.01 g/l, p = 0.319). Eight studies (670 patients) reported data on the need for transfusion after surgery. The overall relative risks (RR) showed a significant difference between the TXA and control group, with a lower risk of transfusion in the TXA group (RR = 0.547, 95%CI = 0.308 to 0.972, p = 0.04).

Conclusions: The meta-analysis of the data reveals that TXA usage is associated with a significant reduction in intraoperative and total blood loss, a lower risk of transfusion, and a non-significant change in postoperative Hb levels in AS surgery However, it should be noted that the surgical operation situations varied across different studies. Therefore, further research is required to investigate the effects of TXA on specific subgroups of gender, operation time, and blood transfusion indicators. Overall, our study provides valuable evidence for the clinical management of AS surgery and may inform the development of practice guidelines and protocols for the use of TXA in this setting.

Keywords: Adolescent scoliosis; Blood loss; Blood transfusion; Tranexamic acid.

Fig. 1

The bias assessment for RCTs. Deviations from intended interventions and the Randomization process have some concerns, and overall the RCTs have moderate concerns

Fig. 2

The bias assessment for RCTs. The specific evaluation of all articles shows that a total of 4 articles have concerns about their components

Fig. 3

The overall assessment for different variables. (a) Interoperation Blood Loss; (b) Total Blood Loss; (c) Postoperative Hb Level; (d) Need for Transfusion. Axis Left: TXA group; Axis Right: Control group; Effect: Mean Difference; RR = Relative Risk; TXA = Tranexamic acid

Fig. 4

The funnel plot for different variables. (a) Interoperational Blood Loss; (b) Total Blood Loss; (c) Postoperative Hb level; (d) Need for Transfusion. Hb = hemoglobin

Fig. 5

The overall assessment of the change in Hb level. Axis Left: TXA group; Axis Right: Control group; Effect: Mean Difference; TXA = Tranexamic acid; Hb = hemoglobin

Fig. 6

The funnel plot for the change in Hb level

Fig. 7

The pooled outcome for different variables after sensitivity analysis. (a) Interoperation Blood Loss; (b) Total Blood Loss; (c) The Need for Transfusion. Axis Left: TXA group; Axis Right: Control group; Effect: Mean Difference; RR = Relative Risk; TXA = Tranexamic acid