Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Abstract

Objective. To evaluate the efficacy and safety of different dose regimens of intravenous (IV) tranexamic acid (TXA) in adolescent spinal deformity surgery. Methods. Two researchers independently searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science to find studies that met the inclusion criteria. A meta-analysis was performed based on the guidelines of the Cochrane Reviewer’s Handbook. Results. Six randomized controlled trials (RCTs) and eleven non-RCTs were identified, including 1148 patients. According to different dose regimens of IV TXA, the included studies were divided into the high-dose group and the low-dose group. Compared with placebo, both groups had less total blood loss (TBL) (high dose: $\text{WMD}=-1737.55$ , 95% CI: (-2247.16, -1227.94), $P<0.001$ , $I^2=0\%$ ; low dose: $\text{WMD}=-528.67$ , 95% CI: (-666.06, -391.28), $P<0.001$ , $I^2=0\%$ ), intraoperative blood loss (IBL) (high dose: $\text{WMD}=-301.48$ , 95% CI: (-524.3, -78.66), $P=0.008$ , $I^2=60.3\%$ ; low dose: $\text{WMD}=-751.14$ , 95% CI: (-967.21, -535.08), $P<0.001$ , $I^2=0\%$ ), and blood transfusion rates (high dose: $\text{RR}=0.19$ , 95% CI: (0.1, 0.37), $P<0.001$ , $I^2=0\%$ ; low dose: $\text{RR}=0.4$ , 95% CI: (0.18, 0.91), $P=0.029$ , $I^2=57\%$ ). High-dose IV TXA use was associated with more vertebral fusion segments ( $\text{WMD}=0.53$ , 95% CI: (0.23, 0.82), $P<0.001$ , $I^2=31.2\%$ ). Low-dose IV TXA use was associated with shorter operative time ( $\text{WMD}=-18.43$ , 95% CI: (-26.68, -10.17), $P<0.001$ , $I^2=0\%$ ). Conclusion. High-dose and low-dose IV TXA were effective in reducing TBL, IBL, and blood transfusion rates without increasing complications in adolescent patients undergoing spinal deformity surgery. Low-dose IV TXA was effective in reducing the operative time. Both the high-dose and low-dose groups had similar preoperative and postoperative Hb levels compared to the control group.