The effect of antifibrinolytic agents in periacetabular osteotomy: A systematic review and meta-analysis - 12/06/22
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Abstract |
Background |
Periacetabular osteotomy (PAO) is a major hip preservation surgery for developmental dysplasia of the hip. It is inevitably associated with significant blood loss, so it requires frequent transfusions and could be a cause of perioperative morbidity. However, to date, a large number of studies has not evaluated the effect of antifibrinolytic agents in PAO. Therefore we performed a systematic review and meta-analysis to assess if antifibrinolytics would be effective in reducing blood loss and transfusion rate after PAO surgery.
Methods |
In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 4, 2020, that investigated the effect of antifibrinolytic agents in PAO. A pooled analysis was designed to identify differences between antifibrinolytic and control groups focusing on blood loss, transfusion, operation time, postoperative venous thromboembolism (VTE), and length of hospital stay.
Results |
We included five studies involving 507 patients (antifibrinolytic group: 256; control group: 251). The pooled analysis showed that the control group had a greater total estimated blood loss (EBL) than the antifibrinolytic group (mean difference [MD]=−257.60mL, 95% confidence interval [CI] −389.68 to −125.53, p=0.0001), but there were no statistical differences in intraoperative EBL (MD=−46.46mL, 95% CI: −192.57 to 99.64, p=0.53). The allogenic transfusion rate was higher in the control group than in the antifibrinolytic group (odds ratio [OR] 0.21, 95% CI: 0.10–0.43, p<0.0001), but there was no difference in the autogenic transfusion rate (OR 0.35, 95% CI: 0.09–1.43, p=0.14). The pooled result showed no difference in operation time (MD=9.13min, 95% CI: −8.54 to 26.80, p=0.31). For the VTE rate, a pooled analysis was not conducted due to the lack of data. The length of hospital stay showed no differences (MD=−0.51 days, 95% CI: −1.17 to 0.16, p=0.13).
Conclusions |
Antifibrinolytic use in PAO has positive effects in terms of reduced total EBL and allogenic transfusion rate.
Level of evidence |
III; meta-analysis.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Antifibrinolytics, Antifibrinolytic agent, Tranexamic acid, Epsilon-aminocaproic acid, Periacetabular osteotomy, Meta-analysis
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Vol 108 - N° 4
Articolo 103271- Giugno 2022 Ritorno al numero
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Benvenuto su EM|consulte, il riferimento dei professionisti della salute.