The efficacy and safety of high versus low doses of intravenous intraoperative tranexamic acid during spinal fusion in patients with adolescent idiopathic scoliosis: a network meta-analysis of randomized controlled trials
Abstract
Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis entails notable bleeding and transfusion risk, yet optimal tranexamic acid dosing remains undefined. We conducted a network meta-analysis (NMA) comparing high dose, low dose, and no-TXA regimens in this setting. We conducted a PROSPERO-registered NMA (CRD420251033929) of RCTs in AIS patients undergoing PSF. PubMed, CINAHL, EMBASE, reference lists, and grey literature were searched for trials comparing high dose (20–50 mg/kg load; 10–20 mg/kg/h infusion), low dose (10 mg/kg load; 1 mg/kg/h infusion), or no TXA. Outcomes were pooled using a random-effects model to produce mean differences for continuous data and relative risks for binary data. Five RCTs (n = 475) were included. Patients had a frequency‐weighted average (FWA) (SD) age of 15.1 (1.5) years, preoperative Cobb angle of 58.0 (7.9)°, 10.4 (1.3) levels fused, and operative time of 186.9 (62.0) minutes. They were allocated to high‐dose TXA (n = 184), low‐dose TXA (n = 144), or no‐TXA (n = 147) arms. The FWA total EBL was 787.3 (261.5) mL in the high‐dose group, 705.3 (219.0) mL in the low‐dose group, and 1016.3 (492.2) mL in controls. There was no significant difference in EBL between high‐ vs low‐dose TXA (MD −98.3 mL [−646.9, 426.2]). In the NMA, high‐dose TXA reduced total EBL by 319 mL (95% CI −818 to 133) and low‐dose by 219 mL (95% CI −764 to 294) versus no TXA—an 81% probability that no TXA was worst strategy—though neither comparison reached…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 475 participants or records.
Read the paper
Related studies
- Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
- A meta‐analysis of anal cancer incidence by risk group: Toward a unified anal cancer risk scale
- Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
- Exercise interventions in Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials
- Prognostic Significance of Carbonic Anhydrase IX Expression in Cancer Patients: A Meta-Analysis
- Glucocorticoid Resistance: Is It a Requisite for Increased Cytokine Production in Depression? A Systematic Review and Meta-Analysis
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.