Antifibrinolytics reduces blood loss in thoracic surgery: a systematic review and meta‐analysis

Abstract

Background The purpose of this systematic review is to evaluate the efficacy of antifibrinolytics in non‐cardiac thoracic surgery. Methods We searched for all randomized controlled trials on this topic. A set of strict inclusion and exclusion criteria was developed. Six studies were meta‐analysed together then in subgroups of topical tranexamic acid and intravenous aprotinin. We compared postoperative chest drain output, transfusions requirements and duration of hospital stay where available to determine the efficacy of topical tranexamic acid or intravenous aprotinin in reducing blood loss. Results The use of antifibrinolytics reduces 24‐h chest drain output (−290.21 mL [−524.75, −55.66], P = 0.02, I2 = 98%), red blood cell transfusion requirements (−1.27 units [−2.24, −0.30], P = 0.01, I2 = 100%) and shortened duration of hospital stay (−1.81 days [−3.25, −0.36], P = 0.01, I2 = 96%). The subgroup analysis also supported this trend. Conclusion We conclude that the use of antifibrinolytics appears to reduce postoperative blood loss by reducing chest drain output, transfusion requirements and length of stay after thoracic surgery.

Effectiveness of prophylactic doses of tranexamic acid in reducing hemorrhagic events in sleeve gastrectomy

“…One of the effective methods of reducing the risk of postoperative bleeding is using tranexamic acid (TXA) [ 9 ]. It has been well described in cardiac or orthopedic surgery [ 10 , 11 ]. TXA is an antifibrinolytic drug, a synthetic analog of lysine [ 12 ].…”

Antifibrinolytics in the treatment of traumatic brain injury

“…Antifibrinolytic agents have been shown to limit blood loss across a wide range of medical conditions, for example in patients with haemoptysis, epistaxis, haematuria or postpartum haemorrhage, as well as in patients undergoing major surgery, including cardiothoracic, abdominal, orthopaedic or obstetric surgery [4][5][6][7][8][9][10][11][12][13]. It therefore seems plausible that antifibrinolytics should also reduce blood loss in trauma patients.…”