{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T10:14:19Z","timestamp":1793182459024,"version":"4.5.0"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis entails notable bleeding and transfusion risk, yet optimal tranexamic acid dosing remains undefined. We conducted a network meta-analysis (NMA) comparing high dose, low dose, and no-TXA regimens in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a PROSPERO-registered NMA (CRD420251033929) of RCTs in AIS patients undergoing PSF. PubMed, CINAHL, EMBASE, reference lists, and grey literature were searched for trials comparing high dose (20\u201350\u00a0mg\/kg load; 10\u201320\u00a0mg\/kg\/h infusion), low dose (10\u00a0mg\/kg load; 1\u00a0mg\/kg\/h infusion), or no TXA. Outcomes were pooled using a random-effects model to produce mean differences for continuous data and relative risks for binary data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five RCTs (n\u2009=\u2009475) were included. Patients had a frequency\u2010weighted average (FWA) (SD) age of 15.1 (1.5) years, preoperative Cobb angle of 58.0 (7.9)\u00b0, 10.4 (1.3) levels fused, and operative time of 186.9 (62.0) minutes. They were allocated to high\u2010dose TXA (n\u2009=\u2009184), low\u2010dose TXA (n\u2009=\u2009144), or no\u2010TXA (n\u2009=\u2009147) arms. The FWA total EBL was 787.3 (261.5) mL in the high\u2010dose group, 705.3 (219.0) mL in the low\u2010dose group, and 1016.3 (492.2) mL in controls. There was no significant difference in EBL between high\u2010 vs low\u2010dose TXA (MD \u221298.3\u00a0mL [\u2212646.9, 426.2]). In the NMA, high\u2010dose TXA reduced total EBL by 319\u00a0mL (95% CI \u2212818 to 133) and low\u2010dose by 219\u00a0mL (95% CI \u2212764 to 294) versus no TXA\u2014an 81% probability that no TXA was worst strategy\u2014though neither comparison reached statistical significance. When compared per fused level, High\u2010 and low\u2010dose TXA reduced EBL per level by 38.2\u00a0mL (MD \u221238.2 [\u221286.3, 6.1]) and 29.5\u00a0mL (MD \u221229.5 [\u221285.2, 27.3]) versus no TXA, respectively, without statistical significance; however, the no\u2010TXA arm had an 87% probability of being worst for EBL by level. The FWA EBL per level was 78.9\u2009\u00b1\u20096.3\u00a0mL, 78.2\u2009\u00b1\u20097.2\u00a0mL, and 116.3\u2009\u00b1\u200917.8\u00a0mL for high\u2010dose, low\u2010dose, and no\u2010TXA groups (very low certainty). When compared by operative time, high and lowdose TXA reduced EBL per hour by 81.0\u00a0mL\/h (MD \u221281.0 [\u2212250.0, 80.5]) and 60.2\u00a0mL\/h (MD \u221260.2 [\u2212285.0, 160.0]) versus no TXA, respectively, with no statistical significance. FWA EBL per hour was 273.8\u2009\u00b1\u2009112.6\u00a0mL\/h, 315.4\u2009\u00b1\u2009133.6\u00a0mL\/h, and 249.8\u2009\u00b1\u2009150.2\u00a0mL\/h for high dose, low dose, and no TXA (very low certainty). Both TXA arms had no complications vs. one uncontrolled bleed in the no-TXA group (0.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High and low dose TXA in AIS PSF yielded modest, non-significant reductions in total blood loss and per-level EBL. No thromboembolic, neurologic, or renal complications occurred among, underscoring its safety. These results support a case-by-case approach to TXA use and highlight the need for larger, standardized RCTs to confirm its clinical value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01289-y","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T15:24:30Z","timestamp":1769268270000},"page":"1077-1092","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The efficacy and safety of high versus low doses of intravenous intraoperative tranexamic acid during spinal fusion in patients with adolescent idiopathic scoliosis: a network meta-analysis of randomized controlled trials"],"prefix":"10.1007","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-0484","authenticated-orcid":false,"given":"Omkar S.","family":"Anaspure","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony N.","family":"Baumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grayson M.","family":"Talaski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Villers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith D.","family":"Baldwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"1289_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.30","volume":"1","author":"JC Cheng","year":"2015","unstructured":"Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB et al (2015) Adolescent idiopathic scoliosis. 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