Shoahaib Karimi, Victor M. Lu, Mithun Nambiar, Kevin Phan, Anuruthran Ambikaipalan, Ralph J. Mobbs


February 2019, pp 1 - 12 Review Article Read Full Article 10.1007/s00586-019-05911-8

First Online: 09 February 2019

Study design

Systematic review and meta-analysis of randomised controlled trials.

Objective

The purpose of this study is to perform a systematic review and meta-analysis of antifibrinolytic agents for paediatric spine surgery.

Background

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.

Methods

A thorough database search of Medline, PubMed, EMBASE and Cochrane was performed according to PRISMA guidelines, and a systematic review was performed.

Results

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 

Conclusion

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.[Figure not available: see fulltext.]


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