Intervention Review

Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children

  1. Aikaterini Tzortzopoulou1,*,
  2. M Soledad Cepeda2,
  3. Roman Schumann1,
  4. Daniel B Carr3

Editorial Group: Cochrane Anaesthesia Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 2 SEP 2007

DOI: 10.1002/14651858.CD006883.pub2


How to Cite

Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006883. DOI: 10.1002/14651858.CD006883.pub2.

Author Information

  1. 1

    Tufts Medical Center, Department of Anesthesiology, Boston, Massachusetts, USA

  2. 2

    Johnson & Johnson Pharmaceutical Research and Development, Pharmacoepidemiology, Titussville, NJ, USA

  3. 3

    Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, USA

*Aikaterini Tzortzopoulou, Department of Anesthesiology, Tufts Medical Center, 800 Washington street, Boston, Massachusetts, 02111, USA. tzortzokat@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Scoliosis surgery is often associated with substantial blood loss and potential detrimental effects in children. Antifibrinolytic agents are often used to reduce perioperative blood loss. Clinical trials have evaluated their effect in children undergoing surgical correction of scoliosis but no systematic review has been published. We performed a systematic review on the efficacy and safety of antifibrinolytic drugs in children undergoing scoliosis surgery.

Objectives

To assess the efficacy and safety of aprotinin, tranexamic acid and aminocaproic acid in reducing blood loss and transfusion requirements in children undergoing scoliosis surgery.

Search methods

We searched CENTRAL (The Cochrane Library 2007, Issue 3), OVID MEDLINE (1950 to September 3rd 2007), LILACS (1992 to June 20th 2007) and EMBASE (1980 to July 23rd 2007). We also searched conference proceedings from 2003 to 2007 and the clinicaltrials.gov registry. No language restriction was applied.

Selection criteria

We included blinded or unblinded randomized controlled trials that evaluated the effect of antifibrinolytics on perioperative blood loss in children that were 18 years of age or younger and undergoing scoliosis surgery.

Data collection and analysis

Two authors independently performed the data extraction. Primary outcomes were mortality and number of patients transfused. Secondary outcomes were number of patients transfused with allogeneic blood, amount of total blood transfused, total blood loss and adverse events. To assess heterogeneity we used the I2 test and for the quantitative analysis we used a fixed-effect model.

Main results

Six studies fulfilled the inclusion criteria. The total number of participants was 254, of whom 127 were allocated to placebo and 127 to antifibrinolytic drugs. Aprotinin, tranexamic acid and aminocaproic acid were evaluated in two studies each. All studies had placebo as the control group intervention. There were no deaths or any serious adverse events in any study, in either the active or the control group. The risk of being transfused was similar in patients receiving antifibrinolytic drugs or placebo. Antifibrinolytics drugs decreased the amount of blood transfused by 327 ml (95% CI -469.04 to -185.78) and the amount of blood loss by 427 ml (95% CI -602.51 to -250.56). There was no indication of publication bias, however, we cannot rule it out due to the small number of studies included.

Authors' conclusions

The effect of antifibrinolytic drugs on mortality could not be assessed. Antifibrinolytic drugs reduced blood loss and the amount of blood transfused in children undergoing scoliosis surgery; however, their effect on the number of children requiring blood transfusion remains unclear. Aprotinin, tranexamic acid and aminocaproic acid seem to be similarly effective.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Antifibrinolytic agents to reduce blood loss in the surgical correction of scoliosis (abnormal curvatures of the spine) in children

Correction of scoliosis is a surgical procedure in which substantial bleeding occurs, which may lead to serious complications. There are many methods for decreasing and controlling blood loss including the use of drugs that modify the coagulation cascade, such as antifibrinolytic drugs. Antifibrinolytic drugs can reduce the bleeding by preventing the breakdown of a blood clot. The antifibrinolytic drugs evaluated in this systematic review were aprotinin, tranexamic acid and aminocaproic acid. The total number of participants in the included studies was 254, of whom 127 received placebo and 127 received antifibrinolytic drugs. Antifibrinolytic drugs decreased the amount of blood transfused by 327 ml and the amount of blood loss by 427 ml. However, the actual need of transfusion was not significantly decreased. Although no deaths or adverse events were noted with the use of these antifibrinolytic drugs, the number of children evaluated was too small and the duration of follow up too short to draw any conclusion on their safety.

This systematic review showed that antifibrinolytic drugs reduce blood loss, but their effect on the need for blood transfusion as well as their safety remains unclear.