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Efficacy and safety of tranexamic acid in reducing blood loss in scoliosis surgery: a systematic review and meta-analysis

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Abstract

Objective

The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to gather data to evaluate the efficacy and safety of tranexamic acid (TXA) versus placebo after a scoliosis surgery.

Methods

The electronic databases including Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science, and Google database were searched to identify relevant studies published from the time of the establishment of these databases up to May 2016. This systematic review and meta-analysis was performed according to the PRISMA statement criteria. The primary outcomes were total blood loss, intraoperative blood loss, and hemoglobin after surgery. The second outcome is need for transfusion. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary.

Results

A total of 685 patients (347 patients in the TXA group and 338 in the control group) were finally included for this meta-analysis. The pooled results revealed that administration of TXA can decrease the total blood loss after scoliosis surgery [mean difference (MD) = 682.30, 95% confidence interval (CI) −930.60 to −434.00; P = 0.000] and intraoperative blood loss [(MD) = −535.28; 95% CI −683.74 to −368.82; P = 0.000]. For the hemoglobin (Hb) value after scoliosis surgery, TXA can decrease the Hb value for 0.51 dL [(MD) = 0.51; 95% CI 0.25–0.78; P = 0.000]. There is no statistically significant difference between the TXA versus placebo in terms of the need for transfusion (relative risk = 0.55, 95% CI 0.25–1.20, P = 0.132).

Conclusion

Based on the current meta-analysis, TXA can decrease the total blood loss and intraoperative blood loss during scoliosis surgery. It is recommended that it be routinely used in scoliosis surgery. High-dose TXA (>20 mg/kg) is more effective than low-dose TXA (<20 mg/kg) in controlling blood loss. However, for the need for transfusion, more high-quality RCTs need to be identified.

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Author notes

    Authors and Affiliations

    1. Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 Jie Fang Nan Road, Hexi District, Tianjin, 300211, People’s Republic of China

      Qiu-Ming Yuan & Bao-Shan Xu

    2. Tianjin Medical University, Tianjin, 300070, People’s Republic of China

      Qiu-Ming Yuan & Zhi-Hu Zhao

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    1. Qiu-Ming Yuan
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    Correspondence to Bao-Shan Xu.

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    The authors have declared that no competing interests exist.

    Funding

    The authors are grateful for the support by the National Natural Science Foundation of China (No. 81272046), and the Research Foundation of the Tianjin Health Bureau (No. 14KG121), the Research Foundation of the Tianjin Science and Technology Committee (No. 15JCYBJC25300). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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    Yuan, QM., Zhao, ZH. & Xu, BS. Efficacy and safety of tranexamic acid in reducing blood loss in scoliosis surgery: a systematic review and meta-analysis. Eur Spine J 26, 131–139 (2017). https://doi.org/10.1007/s00586-016-4899-0

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