Correction of scoliosis is a surgical procedure in which substantial bleeding occurs, which may lead to serious complications. There are many methods for decreasing and controlling blood loss including the use of drugs that modify the coagulation cascade, such as antifibrinolytic drugs. Antifibrinolytic drugs can reduce the bleeding by preventing the breakdown of a blood clot. The antifibrinolytic drugs evaluated in this systematic review were aprotinin, tranexamic acid and aminocaproic acid. The total number of participants in the included studies was 254, of whom 127 received placebo and 127 received antifibrinolytic drugs. Antifibrinolytic drugs decreased the amount of blood transfused by 327 ml and the amount of blood loss by 427 ml. However, the actual need of transfusion was not significantly decreased. Although no deaths or adverse events were noted with the use of these antifibrinolytic drugs, the number of children evaluated was too small and the duration of follow up too short to draw any conclusion on their safety.
This systematic review showed that antifibrinolytic drugs reduce blood loss, but their effect on the need for blood transfusion as well as their safety remains unclear.