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2015 ; 10
(9
): e0137886
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood
Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and
Meta-Analysis
#MMPMID26382761
Wang M
; Zheng XF
; Jiang LS
PLoS One
2015[]; 10
(9
): e0137886
PMID26382761
show ga
BACKGROUND: Routine use of antifibrinolytic agents in spine surgery is still an
issue of debate. OBJECTIVE: To gather scientific evidence for the efficacy and
safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and
epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing
perioperative blood loss and transfusion requirements in scoliosis surgery.
METHODS: We conducted a systematic review and meta-analysis for randomized
controlled trials (RCTs), retrospective case-control studies, and retrospective
cohort studies on the use of antifibrinolytic agents in scoliosis surgery by
searching in the MEDLINE and EMBASE databases and the Cochrane Database of
Systematic Reviews and Controlled Trials of papers published from January 1980
through July 2014. Safety of the antifibrinolytic agents was evaluated in all
included studies, while efficacy was evaluated in RCTs. RESULTS: Eighteen papers
with a total of 1,158 patients were eligible for inclusion in this study. Among
them, 8 RCTs with 450 patients were included for evaluation of pharmacologic
efficacy (1 RCT was excluded because of a lack of standard deviation data). Mean
blood loss was reduced in patients with perioperative use of antifibrinolytic
agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94
ml), 250.30 ml postoperatively (95% CI, 35.31-465.30), and 601.40 ml overall (95%
CI, 306.64-896.16 ml). The mean volume of blood transfusion was reduced by 474.98
ml (95% CI, 195.30-754.67 ml). The transfusion rate was 44.6% (108/242) in the
patients with antifibrinolytic agents and 68.3% (142/208) in the patients with
placebo. (OR 0.38; 95% CI; 0.25-0.58; P<0.00001, I2 = 9%). All studies were
included for evaluation of safety, with a total of 8 adverse events reported
overall (4 in the experimental group and 4 in the control group). CONCLUSION: The
systematic review and meta-analysis indicated that aprotinin, TXA, and EACA all
significantly reduced perioperative blood loss and transfusion requirements in
scoliosis surgery. There was no evidence that the use of antifibrinolytic agents
was a risk factor for adverse events, especially thromboembolism, in scoliosis
surgery.
|Antifibrinolytic Agents/*therapeutic use
[MESH]
|Blood Loss, Surgical/*prevention & control
[MESH]