IMR Press / RCM / Volume 24 / Issue 4 / DOI: 10.31083/j.rcm2404120
Open Access Systematic Review
Intravenous Tranexamic Acid Reduces Post-Operative Bleeding and Blood Transfusion in Patients Undergoing Aortic Surgery: A PRISMA-Compliant Systematic Review and Meta-Analysis
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1 Department of Anesthesiology, Tianjin Union Medical Center, 300121 Tianjin, China
2 Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, 650000 Kunming, Yunnan, China
3 Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037 Beijing, China
*Correspondence: yuntaiyao@126.com (Yun-tai Yao)
Rev. Cardiovasc. Med. 2023, 24(4), 120; https://doi.org/10.31083/j.rcm2404120
Submitted: 19 August 2022 | Revised: 27 November 2022 | Accepted: 19 December 2022 | Published: 19 April 2023
(This article belongs to the Special Issue Cardiac Anesthesia)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Tranexamic acid (TXA), an antifibrinolytic agent, has been demonstrated to reduce blood loss and transfusion requirements in both cardiac and non-cardiac surgery. However, the evidence regarding the efficacy of intravenous TXA in aortic surgery has been seldomly analyzed. Therefore, the current study was performed to address this question. Methods: Searches of PubMed, EMBASE, OVID, Cochrane Library and CNKI were conducted comprehensively for randomized controlled trials (RCTs) comparing intravenous TXA versus no-TXA. Independently and in duplicate, we reviewed titles, abstracts and full-text articles, extracted data and evaluated bias risks. A random effect or fixed effect model was utilized to pool data. Results: The database search yielded 4 RCTs involving 273 patients. Meta-analysis revealed that, there was a significant reduction in bleeding volume within the first 4 hours post-operatively [(weighted mean difference (WMD) = –74.33; 95% confidence interval (CI): –133.55 to –15.11; p = 0.01)], and the first 24 hours post-operatively [(WMD = –228.91; 95% CI: –352.60 to –105.23; p = 0.0003)], post-operative red blood cell (RBC) transfusion volume [(WMD = –420.00; 95% CI: –523.86 to –316.14; p < 0.00001)], fresh frozen plasma (FFP) transfusion volume [(WMD = –360.35; 95% CI: –394.80 to –325.89; p < 0.00001)] and platelet concentrate (PC) transfusion volume [(WMD = –1.27; 95% CI: –1.47 to –1.07; p < 0.0001)] following intravenous TXA administration. In addition, intravenous TXA administration significantly decreased the incidence of postoperative complications (53/451 (8.2%) vs. 75/421 (13.9%); odds ratio (OR) = 0.47; 95% CI: 0.30 to 0.75; p = 0.001), according to this present meta-analysis. Conclusions: The current study preliminarily demonstrated that, TXA significantly reduced postoperative bleeding, blood transfusion requirements and postoperative complications among patients undergoing aortic surgery. More well-designed studies are warrant to confirm the efficacy and safety of intravenous TXA in patients undergoing aortic surgery.

Keywords
tranexamic acid
aortic surgery
post-operative bleeding
Funding
2014zlgc07/Youth Teacher Training Program of Peking Union Medical College
(CIFMS)-2021-I2M-C&T-B-038/CAMS Innovation Fund for Medical Sciences
Figures
Fig. 1.
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