Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative XXXX and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis.

@entity1 @entity190 @entity928 @entity1635 @entity929 @entity930 @entity1031 @entity927
BACKGROUND: Routine use of antifibrinolytic agents in spine surgery is still an issue of debate. OBJECTIVE: To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, @entity927 ( @entity928 ) and @entity929 ( @entity930 , traditionally known as Amicar) in reducing perioperative @entity190 and transfusion requirements in @entity1635 surgery. METHODS: We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs), retrospective case-control studies, and retrospective cohort studies on the use of antifibrinolytic agents in @entity1635 surgery by searching in the MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews and Controlled Trials of papers published from January 1980 through July 2014. Safety of the antifibrinolytic agents was evaluated in all included studies, while efficacy was evaluated in RCTs. RESULTS: Eighteen papers with a total of 1,158 @entity1 were eligible for inclusion in this study. Among them, 8 RCTs with 450 @entity1 were included for evaluation of pharmacologic efficacy (1 RCT was excluded because of a lack of standard deviation data). Mean @entity190 was reduced in @entity1 with perioperative use of antifibrinolytic agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94 ml), 250.30 ml postoperatively (95% CI, 35.31-465.30), and 601.40 ml overall (95% CI, 306.64-896.16 ml). The mean volume of blood transfusion was reduced by 474.98 ml (95% CI, 195.30-754.67 ml). The transfusion rate was 44.6% (108/242) in the patients with antifibrinolytic agents and 68.3% (142/208) in the @entity1 with placebo. (OR 0.38; 95% CI; 0.25-0.58; P<0.00001, I2 = 9%). All studies were included for evaluation of safety, with a total of 8 adverse events reported overall (4 in the experimental group and 4 in the control group). CONCLUSION: The systematic review and meta-analysis indicated that aprotinin, @entity928 , and @entity930 all significantly reduced perioperative @entity190 and transfusion requirements in @entity1635 surgery. There was no evidence that the use of antifibrinolytic agents was a risk factor for adverse events, especially @entity1031 , in @entity1635 surgery.
