The perioperative efficacy and safety of tranexamic acid in adolescent idiopathic scoliosis.

Abstract

OBJECTIVE\nTo evaluate the efficacy and safety of tranexamic acid (TXA) in patients with adolescent idiopathic scoliosis (AIS) undergoing correction surgery.\n\n\nMETHODS\nA literature search of PubMed, Embase, and Cochrane Library was performed to identify studies published from inception to February 2019. After study selection and data extraction, statistical analysis was performed with RevMan 5.3. The odds ratios (ORs) and weight mean differences (WMDs) with 95% confidence intervals (CIs) for all available clinical outcomes were analyzed using fixed or random effects models.\n\n\nRESULTS\nA total of 12 studies involving 2500 patients were included. Intravenous TXA use was associated with significantly fewer patient received blood transfusion [OR, 0.12; 95%CI, 0.06 to 0.22; P < 0.001], less intraoperative estimated blood loss (EBL) [WMD, -470.07; 95%CI, -645.23 to -294.90; P < 0.001], less intraoperative EBL per segment [WMD, -27.40; 95%CI, -32.80 to -22.00; P < 0.001], less cell salvage blood transfusion [WMD, -106.02; 95%CI, -170.84 to -41.20; P = 0.001], and shorter surgical time [WMD, -26.18; 95%CI, -46.91 to -5.46; P = 0.010]. No significant difference was found in postoperative hemoglobin [WMD, 0.39; 95%CI, -0.07 to 0.86; P = 0.100] and hemoglobin change [WMD, -0.92; 95%CI, -2.90 to 1.07; P = 0.360] between the TXA group and the control group. No renal, thromboembolic, or other major complications associated with TXA were noted in included studies.\n\n\nCONCLUSIONS\nTXA was effective in reducing surgical time, intraoperative EBL and blood transfusion without increasing complications in patients undergoing correction surgery for AIS. However, TXA have no influence on postoperative hemoglobin and hemoglobin change.