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Efficacy and utility of antifibrinolytics in pediatric spine surgery: a systematic review and network meta-analysis

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Abstract

Antifibrinolytics have gained increasing attention in minimizing blood loss and mitigating the risks associated with massive transfusions, including infection and coagulopathy in pediatric patients undergoing spine surgery. Nevertheless, the selection of optimal agent is still a matter of debate. We aim to review the utility of these agents and compare the efficacy of antifibrinolytics in pediatric and adolescent spine surgeries. A comprehensive search was performed in Scopus, Web of Science, and MEDLINE databases for relevant works. Studies providing quantitative data on predefined outcomes were included. Primary outcome was perioperative bleeding between the groups. Secondary outcomes included transfusion volume, rate of complications, and operation time. Twenty-eight studies were included in the meta-analysis incorporating 2553 patients. The use of Tranexamic acid (RoM: 0.71, 95%CI: [0.62–0.81], p < 0.001, I2 = 88%), Aprotinin (RoM: 0.54, 95%CI: [0.46–0.64], p < 0.001, I2 = 0%), and Epsilon-aminocaproic acid (RoM: 0.71, 95%CI: [0.62–0.81], p < 0.001, I2 = 60%) led to a 29%, 46%, and 29% reduction in perioperative blood loss, respectively. Network meta-analysis revealed higher probability of efficacy with Tranexamic acid compared to Epsilon-aminocaproic acid (P score: 0.924 vs. 0.571). The rate of complications was not statistically different between each two antifibrinolytic agent or antifibrinolytics compared to placebo or standard of care. Our network meta-analysis suggests a superior efficacy of all antifibrinolytics compared to standard of care/placebo in reducing blood loss and transfusion rate. Further adequately-powered randomized clinical trials are recommended to reach definite conclusion on comparative performance of these agents and to also provide robust objective assessments and standardized outcome data and safety profile on antifibrinolytics in pediatric and adolescent pediatric surgeries.

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Data availability

The datasets and codes generated for this meta-analysis is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

    Sepehr Aghajanian & Fateme Mohammadifard

  2. Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran

    Sepehr Aghajanian

  3. Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

    Omid Kohandel Gargari

  4. Headache Research Center, Neurology Department, Tehran University of Medical Sciences, Tehran, Iran

    Omid Kohandel Gargari

  5. Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Gilan, Iran

    Arvin Naeimi

  6. Department of Health & Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ayad Bahadorimonfared

  7. Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Aladine A. Elsamadicy

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CRediT Author Statement: Sepehr Aghajanian: Methodology, Software, Validation, Formal analysis, Data curation, Writing- Original Draft, Writing – Review & Editing, Visualization, Project Administration Fateme Mohammadifard: Data curation, Writing – Original Draft Omid Kohandel Gargari: Data curation, Writing – Original Draft Arvin Naeimi: Data curation, Writing – Original Draft Ayad Bahadori Monfared: Formal analysis Aladine A. Elsamadicy: Conception, Writing – Review & Editing, Supervision.

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Aghajanian, S., Mohammadifard, F., Kohandel Gargari, O. et al. Efficacy and utility of antifibrinolytics in pediatric spine surgery: a systematic review and network meta-analysis. Neurosurg Rev 47, 177 (2024). https://doi.org/10.1007/s10143-024-02424-x

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