Antifibrinolytic agents for paediatric scoliosis surgery: a systematic review and meta-analysis

  • Shoahaib KarimiEmail author
  • Victor M. Lu
  • Mithun Nambiar
  • Kevin Phan
  • Anuruthran Ambikaipalan
  • Ralph J. Mobbs
Review Article


Study design

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.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Antifibrinolytic 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.

Supplementary material

586_2019_5911_MOESM1_ESM.pptx (183 kb)
Supplementary material 1 (PPTX 183 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine, Melbourne School of MedicineMelbourne UniversityMelbourneAustralia
  2. 2.Department of Orthopaedic SurgeryWestmead HospitalWestmead, SydneyAustralia
  3. 3.Faculty of MedicineUniversity of SydneySydneyAustralia
  4. 4.Department of SurgeryThe University of MelbourneMelbourneAustralia
  5. 5.Department of Orthopaedic SurgeryBox Hill HospitalMelbourneAustralia
  6. 6.NeuroSpine Surgery Research GroupPrince of Wales Private HospitalRandwick, SydneyAustralia
  7. 7.Department of NeurosurgeryPrince of Wales Public HospitalRandwick, SydneyAustralia

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