• Shoahaib Karimi, Victor M Lu, Mithun Nambiar, Kevin Phan, Anuruthran Ambikaipalan, and Ralph J Mobbs.
• Faculty of Medicine, Melbourne School of Medicine, Melbourne University, Melbourne, VIC, Australia. shoahaibkarimi@gmail.com.
• Eur Spine J. 2019 May 1; 28 (5): 1023-1034.

Study DesignSystematic review and meta-analysis of randomised controlled trials.ObjectiveThe purpose of this study is to perform a systematic review and meta-analysis of antifibrinolytic agents for paediatric spine surgery.BackgroundBleeding is an important consideration in paediatric scoliosis surgery; blood loss leads directly to higher morbidity and mortality. Antifibrinolytics are an attractive non-invasive method of reducing bleeding as evidenced in arthroplasty, cardiac surgery and adult scoliosis surgery.MethodsA thorough database search of Medline, PubMed, EMBASE and Cochrane was performed according to PRISMA guidelines, and a systematic review was performed.ResultsFive randomised controlled trials were identified in this meta-analysis, consisting of a total of 285 spine surgery patients with subgroups of tranexamic acid (n = 101), epsilon aminocaproic acid (n = 61) and control (n = 123). This meta-analysis found that antifibrinolytics lead to statistically significant reductions in peri-operative blood loss (MD - 379.16, 95% CI [- 579.76, - 178.57], p < 0.001), intra-operative blood loss (MD - 516.42, 95% CI [- 1055.58, 22.74], p < 0.001), reduced fresh frozen plasma requirements (MD - 307.77, 95% CI [- 369.66, - 245.88], p < 0.001) and reduced post-operative blood loss (MD -  185.95, 95% CI [- 336.04, - 35.87], p = 0.02).ConclusionThis meta-analysis concludes that antifibrinolytics lead to statistically significant reductions in peri-operative blood loss, intra-operative blood loss, reduced fresh frozen plasma requirements and reduced post-operative blood loss with TXA. These slides can be retrieved under Electronic Supplementary Material.

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