Antifibrinolytic agents for paediatric scoliosis surgery: a systematic review and meta-analysis
Systematic review and meta-analysis of randomised controlled trials.
The purpose of this study is to perform a systematic review and meta-analysis of antifibrinolytic agents for paediatric spine surgery.
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.
A thorough database search of Medline, PubMed, EMBASE and Cochrane was performed according to PRISMA guidelines, and a systematic review was performed.
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).
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.
KeywordsAntifibrinolytic agents Paediatric spine surgery Tranexamic acid Epsilon aminocaproic acid
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest and no funding was provided to aid this research.
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