Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

OBJECTIVE: To evaluate the efficacy and safety of different dose regimens of intravenous (IV) tranexamic acid (TXA) in adolescent spinal deformity surgery. METHODS: Two researchers independently searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science to find studies that met the inclusion criteria. A meta-analysis was performed based on the guidelines of the Cochrane Reviewer's Handbook. RESULTS: Six randomized controlled trials (RCTs) and eleven non-RCTs were identified, including 1148 patients. According to different dose regimens of IV TXA, the included studies were divided into the high-dose group and the low-dose group. Compared with placebo, both groups had less total blood loss (TBL) (high dose: WMD = −1737.55, 95% CI: (-2247.16, -1227.94), P < 0.001, I(2) = 0%; low dose: WMD = −528.67, 95% CI: (-666.06, -391.28), P < 0.001, I(2) = 0%), intraoperative blood loss (IBL) (high dose: WMD = −301.48, 95% CI: (-524.3, -78.66), P = 0.008, I(2) = 60.3%; low dose: WMD = −751.14, 95% CI: (-967.21, -535.08), P < 0.001, I(2) = 0%), and blood transfusion rates (high dose: RR = 0.19, 95% CI: (0.1, 0.37), P < 0.001, I(2) = 0%; low dose: RR = 0.4, 95% CI: (0.18, 0.91), P = 0.029, I(2) = 57%). High-dose IV TXA use was associated with more vertebral fusion segments (WMD = 0.53, 95% CI: (0.23, 0.82), P < 0.001, I(2) = 31.2%). Low-dose IV TXA use was associated with shorter operative time (WMD = −18.43, 95% CI: (-26.68, -10.17), P < 0.001, I(2) = 0%). CONCLUSION: High-dose and low-dose IV TXA were effective in reducing TBL, IBL, and blood transfusion rates without increasing complications in adolescent patients undergoing spinal deformity surgery. Low-dose IV TXA was effective in reducing the operative time. Both the high-dose and low-dose groups had similar preoperative and postoperative Hb levels compared to the control group.