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

The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to gather data to evaluate the efficacy and safety of tranexamic acid (TXA) versus placebo after a scoliosis surgery. The electronic databases including Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science, and Google database were searched to identify relevant studies published from the time of the establishment of these databases up to May 2016. This systematic review and meta-analysis was performed according to the PRISMA statement criteria. The primary outcomes were total blood loss, intraoperative blood loss, and hemoglobin after surgery. The second outcome is need for transfusion. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary. A total of 685 patients (347 patients in the TXA group and 338 in the control group) were finally included for this meta-analysis. The pooled results revealed that administration of TXA can decrease the total blood loss after scoliosis surgery [mean difference (MD) = 682.30, 95% confidence interval (CI) -930.60 to -434.00; P = 0.000] and intraoperative blood loss [(MD) = -535.28; 95% CI -683.74 to -368.82; P = 0.000]. For the hemoglobin (Hb) value after scoliosis surgery, TXA can decrease the Hb value for 0.51 dL [(MD) = 0.51; 95% CI 0.25-0.78; P = 0.000]. There is no statistically significant difference between the TXA versus placebo in terms of the need for transfusion (relative risk = 0.55, 95% CI 0.25-1.20, P = 0.132). Based on the current meta-analysis, TXA can decrease the total blood loss and intraoperative blood loss during scoliosis surgery. It is recommended that it be routinely used in scoliosis surgery. High-dose TXA (> 20 mg/kg) is more effective than low-dose TXA (< 20 mg/kg) in controlling blood loss. However, for the need for transfusion, more high-quality RCTs need to be identified.