Efficacy and safety of high-dose versus low-dose versus no tranexamic acid in adolescent idiopathic scoliosis surgery: A Bayesian network meta-analysis.
Systematic Review
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./r/nThis network meta-analysis (NMA) aimed to compare high and low doses of TXA, along with a control without TXA, for AIS surgery./r/nThree 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./r/nAfter 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./r/nBoth 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.
