Meta-analysis on antifibrinolytic agents for spinal surgery

English Keywords:Antifibrinolytic agents  Spinal surgery  Hemostasis  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To systematically assess the antifibrinolytic agents for spinal surgery. Methods: According to the computer-based online search of PubMed, Embase, Medline, Cochrane Library, CBM, CNKI, Wanfang Database, VIP for articles published before June 1st, 2016 were searched for articles on antifibrinolytic agents(AA) for spinal surgery. Group AA included tranexamic acid(TXA) and epsilon aminocaproic acid(EACA); control group(CG) included placebo. 18 randomized controlled trials(RCTs) were included for the present study． Two authors independently assessed trial quality and extracted data． The data of total blood loss, intraoperative blood loss, postoperative blood loss, total blood transfusion, intraoperative transfusion, postoperative transfusion, operation time, adverse events were abstracted and synthesized by Review Manager 5.3 for Meta-analysis. Reasults: 18 studies were included with a total of 1571 patients. The methodological quality score of 9 RCT studies included in the Meta-analysis was 5, which of 6 studies was 4 and 3 studies was 3. Ten studies with total blood loss were reported: TXA VS. Placebo[SMD=-0.95; 95%CI:(-1.28, -0.62), P＜0.00001]; EACA VS. Placebo[SMD=-0.91; 95%CI:(-1.24, -0.58), P＜0.00001]; TXA VS. EACA[SMD=0.13; 95%CI:(-0.47, -0.73), P=0.67]. 13 studies with intraoperative blood loss were reported: TXA VS. Placebo[SMD=-0.47; 95%CI:(-0.66, -0.29), P＜0.00001]; EACA VS. Placebo[SMD=-1.01; 95%CI:(-1.56, -0.47), P＜0.0003]; TXA VS. EACA[SMD=0.47; 95%CI:(0.13, 0.81), P=0.007]. 8 studies with postoperative blood loss were reported: TXA VS. Placebo[SMD=-0.74; 95%CI:(-1.13, -0.34), P=0.0002]; EACA VS. Placebo Placebo[SMD=-0.80; 95%CI:(-1.44, -0.16), P=0.01]; TXA VS. EACA [SMD=0.06; 95%CI:(-1.02, 1.14), P=0.92]. 7 studies with total blood transfusion were reported [SMD=-0.51; 95%CI:(-0.67, -0.34), P＜0.00001]. 4 studies with intraoperative transfusion were reported [RR=0.91; 95%CI:(0.68, 1.21), P=0.52]. 6 studies with postoperative transfusion were reported[RR=0.44; 95%CI:(0.31, 0.62), P＜0.00001]. 8 studies with operation time were reported [SMD=-0.04; 95%CI:(-0.21, 0.14), P=0.69]. 3 studies with adverse events were reported [RR=1.07; 95%CI:(0.24, 4.81), P=0.93]. Conclusions: Administration of antifibrinolytic agents in perioperative period of spinal surgery may help not in reducing total blood loss, intraoperative blood loss, postoperative blood loss, total blood transfusion,postoperative transfusion, but in intraoperative transfusion, operation time, adverse events.