scholarly journals Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0137886 ◽  
Author(s):  
Meng Wang ◽  
Xin-Feng Zheng ◽  
Lei-Sheng Jiang
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Meta Analysis ◽  
Scoliosis Surgery ◽  
Efficacy And Safety ◽  
Antifibrinolytic Agents ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements

scholarly journals 1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Varma ◽  
R Donovan ◽  
M Whitehouse ◽  
S Kunutsor ◽  
A Blom
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements ◽  
Elbow Replacement

Abstract Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 350-362 ◽  
Author(s):  
Idris Ghijselings ◽  
Dirk Himpe ◽  
Steffen Rex
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Postoperative Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Secondary Outcomes

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

scholarly journals Efficacy and Safety of Tranexamic Acid in Reducing Blood Loss of Lower Extremity Osteotomy in Peri‐acetabulum and High Tibia: A Systematic Review and Meta‐analysis

2019 ◽  
Vol 11 (4) ◽  
pp. 545-551 ◽  
Author(s):  
Ru‐zhan Yao ◽  
Wei‐qiang Gao ◽  
Bing‐wu Wang ◽  
Guang‐lin Wang ◽  
Cheng‐xi Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Lower Extremity ◽  
Tranexamic Acid ◽  
Meta Analysis ◽  
Efficacy And Safety

Antifibrinolytic agents for paediatric scoliosis surgery: a systematic review and meta-analysis

2019 ◽  
Vol 28 (5) ◽  
pp. 1023-1034 ◽  
Author(s):  
Shoahaib Karimi ◽  
Victor M. Lu ◽  
Mithun Nambiar ◽  
Kevin Phan ◽  
Anuruthran Ambikaipalan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Scoliosis Surgery ◽  
Antifibrinolytic Agents

scholarly journals The efficacy and safety of high-dose tranexamic acid in adolescent idiopathic scoliosis: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Indra K. Shrestha ◽  
Tian-Yi Ruan ◽  
Lan Lin ◽  
Miao Tan ◽  
Xue-Qing Na ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
High Dose ◽  
Scoliosis Surgery ◽  
Random Effects Model ◽  
Efficacy And Safety ◽  
Weighted Mean

Abstract Background This study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery. Methods This study was a meta-analysis, which consisted of retrospective cohort studies (RCSs) and randomized control trials (RCTs) found by searching electronic databases, namely PubMed, Web of Science, The Cochrane Central Register of Controlled Trials (CENTRAL), and the Google Scholar Database, dating from 1960 to 2019. The points of interest included total blood loss, a need for transfusion and transfusion criteria, surgery time, and the evidence of intraoperative and postoperative complications, such as seizures or thromboembolic events. The weighted mean differences (WMD) and 95% confidence interval (CI) of blood loss in the TXA intervention group compared to the control or placebo group were extracted and combined using the random effects model. Results In this meta-analysis, there was a total of three RCSs and two RCTs, which involved 334 patients. The results showed that blood loss is significantly reduced, with a weighted mean difference in the TXA group (WMD = − 525.14, P = 0.0000, CI ranged from − 839.83, − 210.44, I2 = 82%). Heterogeneity was assessed using the random effects model. Conclusions A high dose of intravenous TXA reduced blood loss during adolescent idiopathic scoliosis surgery and did not lead to any significant thromboembolic event. Therefore, a high dose appears to be effective and safe for adolescent idiopathic scoliosis surgery. However, more high-quality research based on larger randomized controlled trials is still needed.

Safety and Efficacy of Anti-Fibrinolytics in Orthopedic Surgery: A Meta-Analysis of Randomized Trials.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 628-628
Author(s):  
Yoan K. Kagoma ◽  
Adeela Nematullah ◽  
Wendy P. Lim ◽  
Mark A. Crowther
Keyword(s):  
Venous Thromboembolism ◽  
Blood Loss ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Orthopedic Procedures ◽  
Cochrane Central Register ◽  
Fibrinolytic Agents ◽  
Total Blood ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements

Abstract Background: Minimizing blood transfusions following elective orthopedic procedures is desirable given the risks associated with transfusion, including cost, infection, and allergic reactions. Anti-fibrinolytic agents may reduce perioperative blood loss but are used infrequently possibly due to a lack of data supporting their efficacy and concerns about increased risks for venous thromboembolism (VTE). We performed a meta-analysis to determine whether anti-fibrinolytic agents reduce perioperative blood loss in patients undergoing total hip replacement (THR) or total knee arthroplasty (TKA). Data sources: MEDLINE (1966 to May Week 3 2006), EMBASE (1980 to 2006 Week 21), Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials (the latter four databases to May 29, 2006) were searched. Additional trials were identified by manual searches. Authors and/or pharmaceutical companies were contacted if required. Study selection was based on the following criteria: prospective randomized clinical trials in which tranexamic acid, epsilon-aminocaproic acid, or aprotinin were administered. Two independent reviewers abstracted transfusion requirements, total blood loss, and venous thromboembolism. Study quality was assessed using the Jadad Quality Assessment scale. Data was pooled using the Mantel-Haenszel method and a random effects model. Results: In 25 studies involving 1332 patients, the weighted mean difference (WMD) in total blood loss in patients treated with anti-fibrinolytic agents compared to patients receiving placebo was −409.50 mL (95%CI, −548.17 to −270.82; P< 0.00001, I2 = 89.6%). In 1557 patients, the relative risk (RR) for transfusion was 0.52 (95%CI, 0.42 to 0.64; P<0.00001, I2 = 58.0%). VTE did not appear to be increased in patients who received anti-fibrinolytic agents (RR 0.972 (95%CI, 0.885 to 1.06). Conclusions: Patients undergoing TKR or THA who receive anti-fibrinolytic agents appear to have reductions in blood loss and need for transfusion. Whether these medications increase VTE risk cannot be determined due to limited data. Study characteristics were heterogeneous and the optimal timing, dose, and type of anti-fibrinolytic therapy have yet to be determined. Further studies in this area are warranted.

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