Gausden Elizabeth B, Brusalis Christopher M, Qudsi Rameez A, Swarup Ishaan, Fu Michael, Dodwell Emily, Fabricant Peter D
Hospital for Special Surgery.
Harvard Combined Orthopaedic Residency, Boston, Massachusetts, USA.
J Pediatr Orthop B. 2020 Jan;29(1):97-104. doi: 10.1097/BPB.0000000000000599.
Antifibrinolytics (AFs) stabilize blood clot formation and reduce bleeding. The purpose of this systematic review and meta-analysis was to determine the impact of AF use on intraoperative blood loss and the need for blood transfusion in pediatric orthopedic surgery. A systematic review was performed using Medline and Embase to identify studies that utilized AFs during pediatric orthopedic surgery. The primary outcome measure was intraoperative blood loss in ml. Secondary outcomes included blood transfusion and thromboembolic events. Pooled estimates were derived from a random-effects model. Heterogeneity was assessed using the Cochrane Q and I statistic. Meta-regression assessed if age or study quality modified the effect of AFs on blood loss. Publication bias was assessed using a funnel plot, Egger regression analysis, and the Kendall τ-test. Twenty studies, with a total of 1356 patients, were included. The mean difference in intraoperative blood loss was 653 ml [95% confidence interval (CI): 464-842 ml, P < 0.001]. Similarly, the mean difference in percent of blood volume lost was 22% less in patients treated with AFs compared with controls (95% CI: 12-32, P < 0.001). Patients treated with AFs had a lower odds of transfusion compared to controls (OR: 0.324; 95% CI: 0.105-0.997, P = 0.049). The use of AF in pediatric orthopedic surgery results in decreased intraoperative blood loss and a lower risk of blood transfusion. The majority of studies included involve spine surgery; the benefits of AFs in extremity surgery in the pediatric population have yet to be delineated. Level of Evidence: Level II.
抗纤溶药物（AFs）可稳定血凝块形成并减少出血。本系统评价和荟萃分析的目的是确定AFs在小儿骨科手术中对术中失血及输血需求的影响。使用Medline和Embase进行系统评价，以识别在小儿骨科手术中使用AFs的研究。主要结局指标是术中失血量（以毫升计）。次要结局包括输血和血栓栓塞事件。汇总估计值来自随机效应模型。使用Cochrane Q和I统计量评估异质性。Meta回归评估年龄或研究质量是否改变了AFs对失血的影响。使用漏斗图、Egger回归分析和Kendall τ检验评估发表偏倚。纳入了20项研究，共1356例患者。术中失血量的平均差异为653毫升[95%置信区间（CI）：464 - 842毫升，P < 0.001]。同样，与对照组相比，接受AFs治疗的患者失血量占血容量百分比的平均差异少22%（95%CI：12 - 32，P < 0.001）。与对照组相比，接受AFs治疗的患者输血几率更低（OR：0.324；95%CI：0.105 - 0.997，P = 0.049）。在小儿骨科手术中使用AFs可减少术中失血并降低输血风险。大多数纳入研究涉及脊柱手术；AFs在小儿四肢手术中的益处尚未明确。证据级别：二级。
