Antifibrinolytic agents for paediatric scoliosis surgery: a systematic review and meta-analysis

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 < 0.001), intra-operative blood loss (MD − 516.42, 95% CI [− 1055.58, 22.74], p < 0.001), reduced fresh frozen plasma requirements (MD − 307.77, 95% CI [− 369.66, − 245.88], p < 0.001) and reduced post-operative blood loss (MD − 185.95, 95% CI [− 336.04, − 35.87], p = 0.02). 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.