Antifibrinolytic agents reduce blood loss and transfusion requirements in spine surgery .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(3):23 PLoS One. 2013 Nov 22;8(11):e820639 randomized controlled studies, with a total of 664 patients, were included in this meta-analysis to compare antifibrinolytic agents such as tranexamic acid (TXA) and epsilonaminocaproic acid (EACA), to a placebo in regards to blood loss, transfusion requirements and deep vein thrombosis incidence in patients who underwent spine surgery. The antifibrinolytic agents were effective in reducing total blood loss, total blood transfusion and ratio of blood transfusion; additionally, the incidence of deep vein thrombosis was comparable between the antifibrinolytic agents and the placebos used.
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نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Spine surgery, particularly multilevel spinal fusion, deformity correction and anterior-posterior spinal fusion, are associated with significant blood loss and transfusion requirements. Transfusions can be the cause of a variety of complications which can be decreased with autologous blood donations, application of cell saver-systems or the use of erythropoietin; however, these solutions are expensive and logistically challenging. Intraoperative administration of antifibrinolytics such as tranexamic acid (TXA), epsilonaminocaproic acid (EACA) and aprotinin are becoming more popular in spine surgery. Recent high-quality evidence provides reason to conduct a current meta-analysis on the topic; therefore, this study was conducted to determine the effects of antifibrinolytic agents on reducing perioperative blood loss in spine surgery.
ما هو سؤال البحث الرئيسي؟
What are the effects of antifibrinolytic agents such as tranexamic acid (TXA) and epsilonaminocaproic acic (EACA) on perioperative blood loss and transfusion requirements in patients undergoing spine surgery?
- 8 studies reported on total blood loss, the overall effect was significantly different in favour of the intervention (WMD =-288.8, 95 % CI -46.49 to -110.19; p = 0.002).Subgroup analyses of 6 studies that examined TXA and 2 studies evaluating EACA resulted in similar conclusions (WMD =-285.3, 95 % CI -506.99 to -63.65; p = 0.01 and WMD =-338.1, 95 % CI -583.03 to -93.33; p = 0.007, respectively).
- The 9 studies that reported on total blood transfusion and found a significant difference in favour of antifibrinolytic agents(WMD =-242.76, 95 % CI -422.5 to -62.95; p = 0.008). Subgroup analysis of 6 studies involving TXA indicated significant differences in favour of TXA (WMD=-242.76, 95 % CI -422.5 to -62.95; p = 0.008) and 3 studies display improved results with EACA as well compared to a placebo (WMD =-358.1, 95 % CI -608.49 to -107.71; p = 0.005)
- Ratio of blood transfusion was available in 7 studies and overall antifibrinolytic agents proved superior over the placebo (RR = 0.73, 95% CI 0.58 to 0.93; p = 0.010). A subgroup analysis of TXA alone resulted in similar findings (RR =0.71, 95 % CI 0.54 to 0.92; p= 0.01).
- 9 Studies examined the DVT incidence and found no difference between groups (RR 0.25, 95 % CI 0.03 to 2.22; p= 0.21).
ما الذي يجب أن أتذكره أكثر؟
The antifibrinolytic agents tranexamic acid (TXA) and epsilonaminocaproic acid (EACA) were both effective in reducing total blood loss, total blood transfusion and ratio of blood transfusion. The incidence of deep vein thrombosis was comparable between the antifibrinolytic agents and the placebos used.
كيف سيؤثر ذلك على رعاية مرضاي؟
Results of this study suggest that patients undergoing spine surgery can benefit from the administration of antifibrinolytic agents such as tranexamic acid and epsilonaminocaproic acid in terms of reducing blood loss and transfusion requirements. This study was limited by the small sample sizes of the included trials and the heterogeneity in variation in drug dose, surgical procedure, operation time, age of patients, protocol for estimating blood loss and transfusion indication. All of the included studies featured intravenous administration of the study drugs; whether there is a role of topical agents in spine surgery remains to be determined.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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