Prophylactic Topical Tranexamic Acid Versus Placebo in Surgical Patients

Abstract

Objectives: Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and efficacy profile remain unclear in the literature. The primary aim of this review was to assess the effect of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery. Data sources: EMBASE, MEDLINE, CENTRAL, and ISI Web of Science were systematically searched from their inception until May 31, 2019. Review methods: Parallel-arm randomized controlled trials were included. Results: Seventy-one trials (7539 participants: orthopedics 5450 vs nonorthopedics 1909) were included for quantitative meta-analysis. In comparison to placebo, topical TXA significantly reduced intraoperative blood loss [mean difference (MD) À36.83 mL, 95% confidence interval (CI) À54.77 to À18.88, P < 0.001], total blood loss (MD À319.55 mL, 95% CI À387.42 to À251.69, P < 0.001), and incidence of blood transfusion [odds ratio (OR) 0.30, 95% CI 0.26-0.34, P < 0.001]. Patients who received topical TXA were associated with a shorter length of hospital stay (MD À0.28 days, 95% CI À0.47 to À0.08, P ¼ 0.006). No adverse events associated with the use of topical TXA were observed, namely mortality (OR 0.78, 95% CI 0.45-1.36, P ¼ 0.39), pulmonary embolism (OR 0.73, 95% CI 0.27-1.93, P ¼ 0.52), deep vein thrombosis (OR 1.07, 95% CI 0.65-1.77, P ¼ 0.79), myocardial infarction (OR 0.79, 95% CI 0.21-2.99, P ¼ 0.73), and stroke (OR 0.85, 95% CI 0.28-2.57, P ¼ 0.77). Of all included studies, the risk of bias assessment was ''low'' for 20 studies, ''unclear'' for 26 studies and ''high'' for 25 studies. Conclusions: In the meta-analysis of 71 trials (7539 patients), topical TXA reduced the incidence of blood transfusion without any notable adverse events associated with TXA in adults undergoing surgery. PROSPERO: CRD 42018111762.

Effect of tranexamic acid in arthroscopic anterior cruciate ligament repair: A systematic review and meta-analysis of randomised clinical trials

“…[27][28][29][30] A recently published meta-analysis of 71 RCTs (7539 patients) also concluded that topical use of TXA reduced intraoperative blood loss and blood transfusion in surgical patients without any notable adverse events associated with TXA. 18 The present meta-analysis reported that TXA reduced postoperative blood loss (approximately 80 ml) in patients undergoing arthroscopic ACLR surgery. This seems like a negligible amount of blood loss to an adult, however the accumulation of such amount of blood loss in the operated knee joint will result in severe joint complications, such as haemarthrosis and septic arthritis.…”

“…17 A recent meta-analysis and systematic review comprising of 71 RCTs with 7539 patients showed that topical TXA is effective in reducing postoperative blood loss and incidence of blood transfusion without any significant TXA's adverse events in patients undergoing any surgical procedures. 18 Several recent RCTs investigating the use of intravenous or intra-articular TXA in arthroscopic ACLR surgery were published with conflicting findings. 11,[19][20][21][22] Thus, a systematic review and meta-analysis is warranted to summarise the evidence use of TXA (intravenous or intra-articular) in arthroscopic ACRL surgery before any recommendation is made.…”

Tranexamic acid vs placebo and its impact in bleeding, transfusions and stone-free rates in percutaneous nephrolithotomy: a systematic review and meta-analysis

“…Concerns over increased risk of thrombotic complications have also been studied previously, with both dedicated trials and meta-analysis finding no significant increased risk [ 24 , 25 ]. Taeuber et al, robust meta-analysis of 216 studies with over 125,000 patients is the largest and most current study to date.…”

Comparison of topical versus intravenous tranexamic acid on blood loss in modified radical mastectomy

“…Some researchers also investigated the effect of using TXA topically on the surgical site in favor to get the benefits of reduced loss of blood and improved hemostasis while avoiding the hypercoagulation effects of tranexamic acid, once administered systemically. 11,12 The safety profile and efficacy of topical administration of TXA was still unclear in the literature. 13 Systemic administration of TXA was associated with reduced mean drain output volume in patients who underwent MRM.…”

“…8 A meta-analysis published in 2021 concluded that topically administered TXA was effective in reducing the need for blood transfusion, without causing any significant side effects in patients undergoing surgery. 12 We proposed that topical administration of 15 mg/ml of TXA before wound closure in patients undergoing MRM was a simple, safe, feasible and effective prophylactic measure with minimal adverse effects. It was a costeffective modality, thereby reducing bleeding, the need for further blood transfusions and prevent reoperation due to hemorrhage.…”