Optimal Tranexamic Acid Dosing for Adolescent Idiopathic Scoliosis Surgery: A Frequentist Network Meta-Analysis.

STUDY

DESIGN

Systematic review and network meta-analysis (NMA).

OBJECTIVE

This NMA evaluates the clinical efficacy and safety of various doses of Tranexamic acid (TXA) for adolescent idiopathic scoliosis (AIS) instrumentation.

SUMMARY OF BACKGROUND DATA: TXA is an antifibrinolytic agent widely used in spine surgery. However, the optimal TXA dose remains unclear, especially for younger patients.

METHODS

We performed a systematic search across PubMed, Scopus, Web of Science, and the Cochrane Library up to March 2025. We included studies that compared different TXA doses or patients without TXA in AIS surgery. We evaluated five TXA doses: TXA 0 (control without TXA); TXA 1 (10 mg/kg bolus + 1 mg/kg/hr infusion); TXA 2 (15-20 mg/kg bolus + 1-10 mg/kg/hr infusion); TXA 3 (30-50 mg/kg bolus of TXA + 5-10 mg/kg/hr infusion); and TXA 4 (100 mg/kg bolus of TXA + 10 mg/kg/hr infusion). This meta-analysis compared bleeding volume, surgical time, transfusion rates, length of hospital stay, and complications. Random-effects frequentist NMA was employed. Treatments were ranked with P-scores.

RESULTS

A total of 1,523 patients, mainly aged 13 to 18 years from 16 studies were included in this analysis (eight retrospective studies). TXA 4 outperformed other doses in reducing intraoperative bleeding, operation time, and cell saver volume. TXA 3 also showed significant benefits but was less effective than TXA 4. There was no difference in complication rates, although these data were not uniformly reported in the studies. No evidence of publication bias was found. Quality concerns were observed.

CONCLUSION

The tranexamic acid dose of 100 mg/kg bolus + 10 mg/kg/hr infusion (TXA 4) was the most effective in bleeding control during AIS instrumentation in teenagers. While these results are promising, more randomized trials are needed to directly compare various TXA doses.