Authors: Guang Li TianWei Sun Gan Luo Chao Zhang
Publish Date: 2016/09/26
Volume: 26, Issue: 1, Pages: 140-154
Abstract
Spine surgery is usually associated with large amount of blood loss and blood transfusion Excessive blood loss may cause hypotension inadequate oxygenation of organs necessitate allogeneic blood transfusion and spinal epidural hematoma formation Aprotinin TXA and EACA are antifibrinolytics currently offered as prophylactic agents to reduce surgeryassociated blood loss The purpose of this study was to assess the efficacy of using antifibrinolytic agents in reducing blood loss and blood transfusions in spine surgeryPubMed Embase and Cochranecontrolled trials register were used to identify RCTs published before April 2015 that examined the effectiveness of intravenous aprotinin tranexamic acid TXA and epsilonaminocaproic acid EACA on reduction of blood loss and blood transfusions compared with placebo in spine surgery Randomized controlled trials reported the primary outcome that included total blood loss intraoperative blood loss postoperative blood loss blood transfusion requirements blood transfusion rate and incidence of deep vein thrombosis Metaanalysis was performed using the Stata120 Weighted mean difference with 95 confidence intervals was used to summarize the findings across the trials for continuous outcomes Dichotomous data were expressed as risk ratios with 95 confidence intervals A P 005 was considered statistically significant17 studies involving 1191 patients were identified Among them 13 RCTs with 943 patients were included for the evaluation of total blood loss Compared with the control group the antifibrinolytic agents reduced total blood loss SMD = −062 95 CI −075 −048 P = 0000 The aprotinin group SMD = −080 95 CI −122 −037 P = 0938 The TXA group SMD = −075 95 CI −093 −057 P = 0000 and the EACA group SMD = −028 95 CI −054 −001 P = 0185 Thirteen RCTs with eight hundred and ninety four patients were included for the evaluation of intraoperative blood loss Compared with the control group the antifibrinolytic agents reduced intraoperative blood loss SMD = −041 95 CI −055 −028 P = 0010 The aprotinin group SMD = −062 95 CI −093 −030 P = 0862 The TXA group SMD = −047 95 CI −064 −029 P = 0005 and the EACA group SMD = −016 95 CI −042 −011 P = 0897 Eight RCTs with six hundred and seven patients were included for the evaluation of postoperative blood loss Compared with the control group the antifibrinolytic agents reduced postoperative blood loss SMD = −068 95 CI −085 −051 P = 0000 the aprotinin group SMD = −048 95 CI −085 −012 P = 0036 the TXA group SMD = −080 95 CI −101 −059 P = 0000 and the EACA group SMD = −032 95 CI −068 −004 P = 0009 Ten RCTs with seven hundred and twenty twopatients were included for the evaluation of blood transfusion Compared with the control group the antifibrinolytic agents reduced blood transfusion SMD = −068 95 CI −085 −051 P = 0000 the aprotinin group SMD = −080 95 CI −122 −037 P = 0938 the TXA group SMD = −038 95 CI −058 −018 P = 0000 and the EACA group SMD = −028 95 CI −054 −001 P = 0185 Twelve RCTs with eight hundred and fifteenpatients were included for the evaluation of blood transfusion rate The transfusion rate was 356 in the patients with antifibrinolytic agents and 552 in the patients with placebo RR = 075 95 CI 063 089 P = 0939 All studies were included for the evaluation of safety with a total of eight thromboembolic events reported overall two in the experimental group and six in the control groupThe antifibrinolytic agents were able to reduce perioperative blood loss and transfusion requirements in spine surgery TXA appeared more effective than aprotinin and EACA in reducing total blood loss intraoperative blood loss and blood transfusion according to the results of this analysis The three groups in reducing the postoperative blood loss are significantly better than control groups There was no evidence that the use of antifibrinolytic agents was a risk factor for thromboembolism in spine surgery Further multicenter largesample doubleblind RCTs are required to confirm the efficacy and safety of the three antifibrinolytic agents in spine surgery
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