Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis
Routine use of antifibrinolytic agents in spine surgery is still an issue of debate. To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing periope...
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| description | Routine use of antifibrinolytic agents in spine surgery is still an issue of debate.
To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing perioperative blood loss and transfusion requirements in scoliosis surgery.
We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs), retrospective case-control studies, and retrospective cohort studies on the use of antifibrinolytic agents in scoliosis surgery by searching in the MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews and Controlled Trials of papers published from January 1980 through July 2014. Safety of the antifibrinolytic agents was evaluated in all included studies, while efficacy was evaluated in RCTs.
Eighteen papers with a total of 1,158 patients were eligible for inclusion in this study. Among them, 8 RCTs with 450 patients were included for evaluation of pharmacologic efficacy (1 RCT was excluded because of a lack of standard deviation data). Mean blood loss was reduced in patients with perioperative use of antifibrinolytic agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94 ml), 250.30 ml postoperatively (95% CI, 35.31-465.30), and 601.40 ml overall (95% CI, 306.64-896.16 ml). The mean volume of blood transfusion was reduced by 474.98 ml (95% CI, 195.30-754.67 ml). The transfusion rate was 44.6% (108/242) in the patients with antifibrinolytic agents and 68.3% (142/208) in the patients with placebo. (OR 0.38; 95% CI; 0.25-0.58; P |
| doi_str_mv | 10.1371/journal.pone.0137886 |
| format | Article |
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To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing perioperative blood loss and transfusion requirements in scoliosis surgery.
We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs), retrospective case-control studies, and retrospective cohort studies on the use of antifibrinolytic agents in scoliosis surgery by searching in the MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews and Controlled Trials of papers published from January 1980 through July 2014. Safety of the antifibrinolytic agents was evaluated in all included studies, while efficacy was evaluated in RCTs.
Eighteen papers with a total of 1,158 patients were eligible for inclusion in this study. Among them, 8 RCTs with 450 patients were included for evaluation of pharmacologic efficacy (1 RCT was excluded because of a lack of standard deviation data). Mean blood loss was reduced in patients with perioperative use of antifibrinolytic agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94 ml), 250.30 ml postoperatively (95% CI, 35.31-465.30), and 601.40 ml overall (95% CI, 306.64-896.16 ml). The mean volume of blood transfusion was reduced by 474.98 ml (95% CI, 195.30-754.67 ml). The transfusion rate was 44.6% (108/242) in the patients with antifibrinolytic agents and 68.3% (142/208) in the patients with placebo. (OR 0.38; 95% CI; 0.25-0.58; P<0.00001, I2 = 9%). All studies were included for evaluation of safety, with a total of 8 adverse events reported overall (4 in the experimental group and 4 in the control group).
The systematic review and meta-analysis indicated that aprotinin, TXA, and EACA all significantly reduced perioperative blood loss and transfusion requirements in scoliosis surgery. There was no evidence that the use of antifibrinolytic agents was a risk factor for adverse events, especially thromboembolism, in scoliosis surgery.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0137886</identifier><identifier>PMID: 26382761</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acids ; Analysis ; Antifibrinolytic agents ; Antifibrinolytic Agents - therapeutic use ; Blood ; Blood Loss, Surgical - prevention & control ; Blood Transfusion ; Bone surgery ; Care and treatment ; Clinical trials ; Confidence intervals ; Development and progression ; Effectiveness ; Evaluation ; Health aspects ; Humans ; Joint surgery ; Meta-analysis ; Mortality ; Orthopedic surgery ; Patient outcomes ; Patients ; Pharmacology ; Risk factors ; Safety ; Scoliosis ; Scoliosis - surgery ; Spinal Fusion - adverse effects ; Spine ; Studies ; Surgery ; Systematic review ; Thromboembolism ; Transfusion ; Treatment Outcome</subject><ispartof>PloS one, 2015-09, Vol.10 (9), p.e0137886-e0137886</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Wang et al 2015 Wang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-50f64b2ea64cc4f05c443161a0701d28d81968cbf13175135e34bd27e1c009fa3</citedby><cites>FETCH-LOGICAL-c692t-50f64b2ea64cc4f05c443161a0701d28d81968cbf13175135e34bd27e1c009fa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575115/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575115/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26382761$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Fehlings, Michael</contributor><creatorcontrib>Wang, Meng</creatorcontrib><creatorcontrib>Zheng, Xin-Feng</creatorcontrib><creatorcontrib>Jiang, Lei-Sheng</creatorcontrib><title>Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Routine use of antifibrinolytic agents in spine surgery is still an issue of debate.
To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing perioperative blood loss and transfusion requirements in scoliosis surgery.
We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs), retrospective case-control studies, and retrospective cohort studies on the use of antifibrinolytic agents in scoliosis surgery by searching in the MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews and Controlled Trials of papers published from January 1980 through July 2014. Safety of the antifibrinolytic agents was evaluated in all included studies, while efficacy was evaluated in RCTs.
Eighteen papers with a total of 1,158 patients were eligible for inclusion in this study. Among them, 8 RCTs with 450 patients were included for evaluation of pharmacologic efficacy (1 RCT was excluded because of a lack of standard deviation data). Mean blood loss was reduced in patients with perioperative use of antifibrinolytic agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94 ml), 250.30 ml postoperatively (95% CI, 35.31-465.30), and 601.40 ml overall (95% CI, 306.64-896.16 ml). The mean volume of blood transfusion was reduced by 474.98 ml (95% CI, 195.30-754.67 ml). The transfusion rate was 44.6% (108/242) in the patients with antifibrinolytic agents and 68.3% (142/208) in the patients with placebo. (OR 0.38; 95% CI; 0.25-0.58; P<0.00001, I2 = 9%). All studies were included for evaluation of safety, with a total of 8 adverse events reported overall (4 in the experimental group and 4 in the control group).
The systematic review and meta-analysis indicated that aprotinin, TXA, and EACA all significantly reduced perioperative blood loss and transfusion requirements in scoliosis surgery. There was no evidence that the use of antifibrinolytic agents was a risk factor for adverse events, especially thromboembolism, in scoliosis surgery.</description><subject>Acids</subject><subject>Analysis</subject><subject>Antifibrinolytic agents</subject><subject>Antifibrinolytic Agents - therapeutic use</subject><subject>Blood</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Blood Transfusion</subject><subject>Bone surgery</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Development and progression</subject><subject>Effectiveness</subject><subject>Evaluation</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Joint surgery</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Orthopedic surgery</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pharmacology</subject><subject>Risk factors</subject><subject>Safety</subject><subject>Scoliosis</subject><subject>Scoliosis - surgery</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spine</subject><subject>Studies</subject><subject>Surgery</subject><subject>Systematic review</subject><subject>Thromboembolism</subject><subject>Transfusion</subject><subject>Treatment Outcome</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk82O0zAQxyMEYpeFN0BgCQnBocWOEyfZA1JZLVCpaFG7cLVcZ5y6SuKu7RTyTjwk7teqRXtAOTga_-Y_H56JopcEDwnNyIel6Wwr6uHKtDDEwZTn7FF0TgoaD1iM6eOj_7PomXNLjFOaM_Y0OosZzeOMkfPoz7VSWgrZI9GWaCYU-B4ZhUat10rPrW5N3Xst0aiC1jukWzSFspO6rdB3sNqswAqv14A-1caUaGKc20rdWtE61TltNh53nbbQHBRm0tTaOO3QrLMV2P4SjdCsdx4asYk1hbWGX1uZb-DFYBTq7AP-PHqiRO3gxf68iH58vr69-jqY3HwZX40mA8mK2A9SrFgyj0GwRMpE4VQmCSWMCJxhUsZ5mZOC5XKuCCVZSmgKNJmXcQZEYlwoQS-i1zvdVW0c3zfacZKRIg5dplkgxjuiNGLJV1Y3wvbcCM23BmMrLmwopQaezwWVNM4LmbKkpLgohJAJlTjLsGRpHrQ-7qN18wZKGbpkRX0ienrT6gWvzJonaciepEHg3V7AmrsOnOeNdhLqWrRgum3erAhJ0zigb_5BH65uT1UiFKBbZUJcuRHloyQucFoUlAVq-AAVvhIaLcNUKh3sJw7vTxwC4-G3r0TnHB_Ppv_P3vw8Zd8esQsQtV84U3c-zJ47BZMdKG0YUwvqvskE881SHbrBN0vF90sV3F4dP9C902GL6F_ghx5Q</recordid><startdate>20150918</startdate><enddate>20150918</enddate><creator>Wang, Meng</creator><creator>Zheng, Xin-Feng</creator><creator>Jiang, Lei-Sheng</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150918</creationdate><title>Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis</title><author>Wang, Meng ; Zheng, Xin-Feng ; Jiang, Lei-Sheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-50f64b2ea64cc4f05c443161a0701d28d81968cbf13175135e34bd27e1c009fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acids</topic><topic>Analysis</topic><topic>Antifibrinolytic agents</topic><topic>Antifibrinolytic Agents - therapeutic use</topic><topic>Blood</topic><topic>Blood Loss, Surgical - prevention & control</topic><topic>Blood Transfusion</topic><topic>Bone surgery</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Development and progression</topic><topic>Effectiveness</topic><topic>Evaluation</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Joint surgery</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Orthopedic surgery</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Pharmacology</topic><topic>Risk factors</topic><topic>Safety</topic><topic>Scoliosis</topic><topic>Scoliosis - surgery</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spine</topic><topic>Studies</topic><topic>Surgery</topic><topic>Systematic review</topic><topic>Thromboembolism</topic><topic>Transfusion</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Meng</creatorcontrib><creatorcontrib>Zheng, Xin-Feng</creatorcontrib><creatorcontrib>Jiang, Lei-Sheng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Meng</au><au>Zheng, Xin-Feng</au><au>Jiang, Lei-Sheng</au><au>Fehlings, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-09-18</date><risdate>2015</risdate><volume>10</volume><issue>9</issue><spage>e0137886</spage><epage>e0137886</epage><pages>e0137886-e0137886</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Routine use of antifibrinolytic agents in spine surgery is still an issue of debate.
To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing perioperative blood loss and transfusion requirements in scoliosis surgery.
We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs), retrospective case-control studies, and retrospective cohort studies on the use of antifibrinolytic agents in scoliosis surgery by searching in the MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews and Controlled Trials of papers published from January 1980 through July 2014. Safety of the antifibrinolytic agents was evaluated in all included studies, while efficacy was evaluated in RCTs.
Eighteen papers with a total of 1,158 patients were eligible for inclusion in this study. Among them, 8 RCTs with 450 patients were included for evaluation of pharmacologic efficacy (1 RCT was excluded because of a lack of standard deviation data). Mean blood loss was reduced in patients with perioperative use of antifibrinolytic agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94 ml), 250.30 ml postoperatively (95% CI, 35.31-465.30), and 601.40 ml overall (95% CI, 306.64-896.16 ml). The mean volume of blood transfusion was reduced by 474.98 ml (95% CI, 195.30-754.67 ml). The transfusion rate was 44.6% (108/242) in the patients with antifibrinolytic agents and 68.3% (142/208) in the patients with placebo. (OR 0.38; 95% CI; 0.25-0.58; P<0.00001, I2 = 9%). All studies were included for evaluation of safety, with a total of 8 adverse events reported overall (4 in the experimental group and 4 in the control group).
The systematic review and meta-analysis indicated that aprotinin, TXA, and EACA all significantly reduced perioperative blood loss and transfusion requirements in scoliosis surgery. There was no evidence that the use of antifibrinolytic agents was a risk factor for adverse events, especially thromboembolism, in scoliosis surgery.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26382761</pmid><doi>10.1371/journal.pone.0137886</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-09, Vol.10 (9), p.e0137886-e0137886 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acids Analysis Antifibrinolytic agents Antifibrinolytic Agents - therapeutic use Blood Blood Loss, Surgical - prevention & control Blood Transfusion Bone surgery Care and treatment Clinical trials Confidence intervals Development and progression Effectiveness Evaluation Health aspects Humans Joint surgery Meta-analysis Mortality Orthopedic surgery Patient outcomes Patients Pharmacology Risk factors Safety Scoliosis Scoliosis - surgery Spinal Fusion - adverse effects Spine Studies Surgery Systematic review Thromboembolism Transfusion Treatment Outcome |
| title | Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-07T12%3A49%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Efficacy%20and%20Safety%20of%20Antifibrinolytic%20Agents%20in%20Reducing%20Perioperative%20Blood%20Loss%20and%20Transfusion%20Requirements%20in%20Scoliosis%20Surgery:%20A%20Systematic%20Review%20and%20Meta-Analysis&rft.jtitle=PloS%20one&rft.au=Wang,%20Meng&rft.date=2015-09-18&rft.volume=10&rft.issue=9&rft.spage=e0137886&rft.epage=e0137886&rft.pages=e0137886-e0137886&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0137886&rft_dat=%3Cgale_plos_%3EA429059936%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1719288637&rft_id=info:pmid/26382761&rft_galeid=A429059936&rft_doaj_id=oai_doaj_org_article_8ba3c3289c564d3099aac43c0770c658&rfr_iscdi=true |