Efficacy and safety of antifibrinolytic agents in spinal surgery: a network meta-analysis  

作　　者：Lei Yuan Yan Zeng Zhong-Qiang Chen Xin-Ling Zhang Shuo Mai Pan Song Li-Yuan Tao 

机构地区：[1]Department of Orthopedics, Peking University Third Hospital, Beijing 100191,China [2]Department of Urodynamic Center and Urology,The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China [3]Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191,China

出　　处：《Chinese Medical Journal》2019年第5期577-588,共12页中华医学杂志（英文版）

摘　　要：Background: Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-ass oci a ted blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method. Methods: Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1,2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0. Results: Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=-0.65, 95% credibility intervals [CrI;-1.25,-0.06]), low-dose TXA (SMD=-0.58, 95% CrI [-0.92,-0.25]), and high-dose TXA (SMD =-0.70, 95% CrI [-1.04,-0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD=-1.90, 95% CrI [-3.32,-0.48]) and high-dose TXA (SMD =-2.31, 95% CrI [-3.75,-0.87]) had less postoperative blood loss. Low-dose TXA (SMD=-1.07, 95% CrI [-1.82,-0.31]) and high-dose TXA (SMD =-1.07, 95% CrI[-1.82,-0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD =-2.07, 95% CrI [-3.26,-0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD =-1.67, 95% CrI [-3.20,-0.13]). Furthermore, aprotinin (odds ratio [OR]= 0.16, 95% CrI [0.05, 0.54]), EACA (OR = 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR = 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. An

关 键 词：ANTIFIBRINOLYTICS SPINE surgery BLOOD LOSS TRANSFUSION Network META-ANALYSIS 

分 类 号：R[医药卫生]