Does prophylactic tranexamic acid safely reduce bleeding without increasing thrombotic complications in patients undergoing cardiac surgery?

Abstract

SummaryA best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether prophylactic tranexamic acid can safely reduce bleeding without increasing thrombotic complications in patients undergoing cardiac surgery. Altogether 334 papers were found using the reported search, of which 12 represented the best evidence on this topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that tranexamic acid clearly reduces blood loss, requirement for blood transfusion, and the risk of reoperation for bleeding, and although no study has yet looked directly at vein graft patency with tranexamic acid, no randomized studies have raised concerns over its safety. q

Emergency coronary bypass surgery in patients under the influence of dualantiplatelet therapy: effects of tranexamic acid and desmopressin acetate

“…The hemostatic effectiveness of TnX-A in CABG has been shown in previous studies with patient groups undergoing elective surgery (13,14). TnX-A has been reported to reduce blood loss and transfusion requirements without causing thrombotic complications in patients receiving ASA until surgery.…”

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

“…Utilization of TXA has been shown to reduce allogenic blood transfusion in a range of surgical fields (including dental, cardiothoracic, urological, and arthroplasty procedures). [8][9][10] A Cochrane review showed that in an emergency surgical setting, TXA reduced the probability of receiving an erythrocyte transfusion by 30% (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.52-0.94). 11 Previous literature suggests that the use of TXA in hip fracture surgery diminishes blood transfusion requirement with low quality evidence, suggesting no increased risk of thrombolic events.…”

Effectiveness of Tranexamic Acid in Reducing Postoperative Blood Loss in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

“…Antifibrinolytic agents like aprotinin, epsilon-aminocaproic acid (EACA), and TxA have been studied in various randomized trials and meta-analysis for their efficacy in reducing perioperative blood loss in cardiac surgeries [10][11][12][13][14]. Aprotinin being a natural serine protease inhibitor; it has been proven to be associated with increased risks of adverse cardiovascular, cerebrovascular, and renal outcomes [12,13].…”