Efficacy and safety of high-dose versus low-dose versus no tranexamic acid in adolescent idiopathic scoliosis surgery: A Bayesian network meta-analysis.

INTRODUCTION

Corrective surgery for adolescent idiopathic scoliosis (AIS) is a major procedure that often results in significant bleeding. To reduce blood loss, lower costs associated with hospitalization, and improve patient outcomes, tranexamic acid (TXA) has been utilized in surgical procedures.

OBJECTIVE

This network meta-analysis (NMA) aimed to compare high and low doses of TXA, along with a control without TXA, for AIS surgery.

METHODS

Three databases were systematically searched for articles comparing high and low TXA doses, head-to-head, or TXA doses versus control without TXA. Outcomes of interest included blood loss, transfusions, length of operation, and blood parameters. Bayesian NMA was performed with non-informative priors and a random-effects model in R.

RESULTS

After a comprehensive search, 20 studies were included in this review. Both low (<30 mg/kg bolus; MD -256.56 ml (95 % Credible Interval -483.7, -63.07)) and high (≥30 mg/kg; MD -333.11 ml (95 % CrI -603.3, -123.18)) TXA doses significantly reduced intraoperative blood loss compared to the control without TXA. There was no difference between high and low TXA doses in intraoperative blood loss (MD -74.79 ml (95 % CrI -349.36, 178.03)). Total blood loss was lower in the high TXA group compared to the control without TXA (MD -664.5 ml (-1330, -5.41)). Low TXA group showed no significant difference in terms of total blood loss compared to group without TXA or high TXA group. The high-dose arm showed the highest SUCRA ranking in most of the NMA outcomes.

CONCLUSIONS

Both low and high doses of TXA decrease intraoperative blood loss. Moreover, high doses show a significant reduction in total blood loss. Further analysis on seizure or thrombosis events is needed. However, this meta-analysis is mainly based on non-randomized studies, which have notable quality concerns.