Meta-analysis of safety and effectiveness of tranexamic acid in orthopedic surgery for patients with adolescent idiopathic scoliosis

English Keywords:Tranexamic Acid  Idiopathic Scoliosis  Blood Loss  Spinal Surgery  Meta Analysis

English Abstract:

  【Abstract】 Objectives: To systematically analyze the effectiveness and safety of tranexamic acid(TXA) in orthopedic surgery for patients with adolescent idiopathic scoliosis(AIS). Methods: Literature concerning the use of TXA in the orthopedic surgery of AIS patients of randomized controlled trial(RCT) and retrospective cohort studies(RCSs) were searched in the Cochrane library, Web of Science, Embase, PubMed, China National Knowledge Infrastructure(CNKI), and Wanfang Data Knowledge Service Platform, from the inception of the databases to December 2023. The quality of the included literature was evaluated by researchers according to Cochrane evaluation scale for RCT studies and Newcastle-Ottawa Scale(NOS) for RCS studies. The outcome indicators were extracted, including total blood loss, intraoperative blood loss, postoperative drainage, blood transfusion rate, postoperative hemoglobin(Hb) value, operation time, incidence of deep venous thrombosis and related complications. RevMan 5.4 software was used to analyze statistically the extracted data to evaluate the effect of TXA in orthopedic surgery for AIS patients. Results: A total of 8 RCT and 5 RCS studies were included, and all of which were of high-quality, covering 855 patients, with 439 cases in the TXA group and 416 cases in the control group. Meta-analysis results showed that comparing with the control group, the TXA group was lower in intraoperative blood loss[mean difference(MD)=-310.81, 95% confidence interval(CI) (-331.91, -289.72), P<0.01], total blood loss[MD=-431.92, 95%CI(-568.72, -295.13), P<0.01], postoperative drainage[MD=-59.87, 95%CI(-63.98, -55.75), P<0.01], and the blood transfusion rate[odds ratio(OR)=0.17, 95%CI(0.05, 0.53), P=0.003]; shorter in the operation time [MD=-5.94, 95%CI(-10.73, -1.14), P=0.02] and higher in the Hb value after operation[MD=-0.40, 95%CI(-0.26, 0.54), P＜0.01]. No deep venous thrombosis or related complications occurred in both groups. Conclusions: TXA can effectively reduce the intraoperative blood loss, total blood loss, postoperative drainage, blood transfusion rate and operation time in the orthopedic surgery of AIS patients, and maintain the postoperative Hb level without raising the likelihood of thrombosis and related complications.