Efficacy of high-dose versus low-dose tranexamic acid for reduction of blood loss in adolescent idiopathic scoliosis surgery: A systematic review and meta-analysis.

Abstract

Background: Recent studies have suggested that high-dose tranexamic acid (TXA) may be an effective method for reducing blood loss during adolescent idiopathic scoliosis (AIS) surgery. This study aims to perform a systematic review and meta-analysis to compare the outcomes of high-dose versus low-dose TXA for AIS surgery.

Methods: Searches were conducted in major databases such as PubMed, Scopus, Google Scholar, and Cochrane Library for relevant studies comparing high-dose and low-dose TXA outcomes in terms of blood loss, red blood cell transfusions, and hemoglobin changes. This systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered with PROSPERO (CRD42024547735).

Results: Four studies were included, published between 2009 and 2022, encompassing a total of 531 patients. High-dose TXA showed less blood loss compared to low-dose TXA, with a pooled mean difference of -0.40 (95% CI, -0.79--0.01). Neither the volume of blood products used nor the decrease in hemoglobin levels showed significant differences between the groups.

Conclusion: High-dose TXA appears to be more effective in reducing blood loss during AIS surgery compared to low-dose TXA. Further robust clinical trials with larger sample sizes are necessary to confirm these results and establish optimal dosing regimens for maximizing efficacy while ensuring safety.