Efficacy and safety of tranexamic acid in adolescent scoliosis surgery: a systematic review and meta-analysis

Abstract

Abstract Background Although tranexamic acid (TXA) has been widely used in orthopedic surgery, the literature has not established the efficacy of TXA in adolescent scoliosis surgery. The purpose of this systematic review and meta-analysis is to gather data from randomized controlled trials (RCTs) and non-RCTs to evaluate the efficacy and safety of tranexamic acid (TXA) versus placebo treatment during or after adolescent scoliosis surgery. Methods English and Chinese electronic databases including PubMed, Web of Science, Embase, Cochrane, CNKI, and Wan Fang database were searched to identify the relevant literature up until August 2022. The primary outcomes are interoperative blood loss and total blood loss. The secondary outcomes are the need for transfusion, postoperative Hb level, and the change in Hb level. Stata 17 was used for data analysis and the risk of bias was assessed. PRISMA check list is followed to form this article. Results Eight studies (670 patients) reported data on the patients that needed a transfusion after surgery. The overall RR showed that there is a significant difference between the TXA and control group regarding the need for transfusion. (RR = 0.547, 95%CI = 0.308 to 0.972, p = 0.04). Twelve studies (795 participants) were included in the meta-analysis for blood loss during surgery. The results of the meta-analysis suggest that TXA can reduce the blood loss of the patients (SMD= -1.23, 95%CI=-1.79 to -0.68, p = 0.000). Six studies (2027 patients) were included in the meta-analysis for total blood loss. The pooled result shows that the total blood loss of the TXA group was significantly lower than that of the control group (SMD=-0.83, 95%CI= -1.22 to -0.43, p = 0.000). Five studies (419 patients) were included in the meta-analysis for the postoperative Hb level and shows a significant outcome (SMD = 0.45, 95%CI = 0.25 to 0.64, p = 0.000). Three studies (268 patients) were included in the meta-analysis for the postoperative Hb level. There is a significant decrease in the TXA group (SMD= -0.27, 95%CI=-0.52 to -0.02, p = 0.034). Conclusions The meta-analysis of the data reveals that TXA usage has a significantly better hemostatic effect than the placebo for adolescent scoliosis surgery. However, the surgical operation situations in different studies vary. Therefore, further research is required on gender, operation time, blood transfusion indicators, and other surgical operation variables.