Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis

Background: For adults undergoing complex, multilevel spinal surgery, tranexamic acid (TXA) is an antifibrinolytic agent used to reduce blood loss. The optimal dosing of intravenous TXA remains unclear. This systematic review and meta-analysis compare various dosing regimens of intravenous TXA used...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Roman Rahmani, Amy Singleton, Zachary Fulton, John M. Pederson, Thomas Andreshak
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Tranexamic acid Antifibrinolytic agents Blood loss, Surgical Spine Network meta-analysis Dose Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/6674fd2cf1174175a5a02b2bc565825b
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:6674fd2cf1174175a5a02b2bc565825b
record_format	dspace
spelling	oai:doaj.org-article:6674fd2cf1174175a5a02b2bc565825b2021-11-04T04:41:52ZTranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis2666-548410.1016/j.xnsj.2021.100086https://doaj.org/article/6674fd2cf1174175a5a02b2bc565825b2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S266654842100038Xhttps://doaj.org/toc/2666-5484Background: For adults undergoing complex, multilevel spinal surgery, tranexamic acid (TXA) is an antifibrinolytic agent used to reduce blood loss. The optimal dosing of intravenous TXA remains unclear. This systematic review and meta-analysis compare various dosing regimens of intravenous TXA used in patients undergoing multilevel spine surgery (≥2 levels). Methods: PubMed, Cochrane, and EMBASE databases were searched for English language studies published January 2001 through May 2021 reporting use of TXA versus placebo for multilevel spine surgery. Primary outcomes of interest were intraoperative blood loss volume (BLV) and total BLV. A separate random effects model was fit for each outcome measure. Effect sizes were calculated as pooled mean differences (Diff) with corresponding 95% confidence intervals (CIs). Random effects network meta-analyses assessed whether the specific TXA dosing regimen influenced BLV. Results: Seven studies with 441 patients were included for meta-analysis. Four different TXA dosing regimens were found: 1) 10 mg/kg + 1 mg/kg/h, 2) 10 mg/kg + 2 mg/kg/h, 3) 15 mg/kg, 4) 15 mg/kg + 1 mg/kg/h. Compared to placebo, patients treated with TXA had reduced intraoperative BLV (Diff = -185.0 ml; 95% CI: -302.1, -67.9) and reduced total BLV (Diff = -439.0 ml; 95% CI: -838.5, -39.6). No significant differences in intraoperative BLV among any of the TXA treatment groups was found. Patients given a TXA dose of 15 mg/kg + 1 mg/kg/h had significantly reduced total BLV in comparison to both placebo (Diff = -823.1 ml; 95% CI: -1249.8, -396.4) and a dose of 15 mg/kg (Diff = -581.2; 95% CI: -1106.8, -55.7). Conclusions: This study found that intravenous TXA is associated with reduced intraoperative and total BLV, but it remains unclear whether there is an optimal TXA dose. Additional trials directly comparing different TXA regimens and administration routes are needed.Roman RahmaniAmy SingletonZachary FultonJohn M. PedersonThomas AndreshakElsevierarticleTranexamic acidAntifibrinolytic agentsBlood loss, SurgicalSpineNetwork meta-analysisDoseOrthopedic surgeryRD701-811Neurology. Diseases of the nervous systemRC346-429ENNorth American Spine Society Journal, Vol 8, Iss , Pp 100086- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tranexamic acid Antifibrinolytic agents Blood loss, Surgical Spine Network meta-analysis Dose Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Tranexamic acid Antifibrinolytic agents Blood loss, Surgical Spine Network meta-analysis Dose Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429 Roman Rahmani Amy Singleton Zachary Fulton John M. Pederson Thomas Andreshak Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis
description	Background: For adults undergoing complex, multilevel spinal surgery, tranexamic acid (TXA) is an antifibrinolytic agent used to reduce blood loss. The optimal dosing of intravenous TXA remains unclear. This systematic review and meta-analysis compare various dosing regimens of intravenous TXA used in patients undergoing multilevel spine surgery (≥2 levels). Methods: PubMed, Cochrane, and EMBASE databases were searched for English language studies published January 2001 through May 2021 reporting use of TXA versus placebo for multilevel spine surgery. Primary outcomes of interest were intraoperative blood loss volume (BLV) and total BLV. A separate random effects model was fit for each outcome measure. Effect sizes were calculated as pooled mean differences (Diff) with corresponding 95% confidence intervals (CIs). Random effects network meta-analyses assessed whether the specific TXA dosing regimen influenced BLV. Results: Seven studies with 441 patients were included for meta-analysis. Four different TXA dosing regimens were found: 1) 10 mg/kg + 1 mg/kg/h, 2) 10 mg/kg + 2 mg/kg/h, 3) 15 mg/kg, 4) 15 mg/kg + 1 mg/kg/h. Compared to placebo, patients treated with TXA had reduced intraoperative BLV (Diff = -185.0 ml; 95% CI: -302.1, -67.9) and reduced total BLV (Diff = -439.0 ml; 95% CI: -838.5, -39.6). No significant differences in intraoperative BLV among any of the TXA treatment groups was found. Patients given a TXA dose of 15 mg/kg + 1 mg/kg/h had significantly reduced total BLV in comparison to both placebo (Diff = -823.1 ml; 95% CI: -1249.8, -396.4) and a dose of 15 mg/kg (Diff = -581.2; 95% CI: -1106.8, -55.7). Conclusions: This study found that intravenous TXA is associated with reduced intraoperative and total BLV, but it remains unclear whether there is an optimal TXA dose. Additional trials directly comparing different TXA regimens and administration routes are needed.
format	article
author	Roman Rahmani Amy Singleton Zachary Fulton John M. Pederson Thomas Andreshak
author_facet	Roman Rahmani Amy Singleton Zachary Fulton John M. Pederson Thomas Andreshak
author_sort	Roman Rahmani
title	Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis
title_short	Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis
title_full	Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis
title_fullStr	Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis
title_full_unstemmed	Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis
title_sort	tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: a systematic review and network meta-analysis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6674fd2cf1174175a5a02b2bc565825b
work_keys_str_mv	AT romanrahmani tranexamicaciddosingstrategiesandbloodlossreductioninmultilevelspinesurgeryasystematicreviewandnetworkmetaanalysis AT amysingleton tranexamicaciddosingstrategiesandbloodlossreductioninmultilevelspinesurgeryasystematicreviewandnetworkmetaanalysis AT zacharyfulton tranexamicaciddosingstrategiesandbloodlossreductioninmultilevelspinesurgeryasystematicreviewandnetworkmetaanalysis AT johnmpederson tranexamicaciddosingstrategiesandbloodlossreductioninmultilevelspinesurgeryasystematicreviewandnetworkmetaanalysis AT thomasandreshak tranexamicaciddosingstrategiesandbloodlossreductioninmultilevelspinesurgeryasystematicreviewandnetworkmetaanalysis
_version_	1718445216712622080

Tranexamic acid dosing strategies and blood loss reduction in multilevel spine surgery: A systematic review and network meta-analysis

Ejemplares similares