Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Hepatic Surgery: A Systematic Review and Meta‐Analysis

Abstract

Introduction Perioperative bleeding poses a major risk during liver surgery, which can result in increased transfusion requirements, morbidity, and mortality. Tranexamic acid (TXA) effectively reduces perioperative bleeding and transfusion requirements in trauma patients. However, there remains a lack of evidence of its use in liver surgery. This meta-analysis of randomised controlled trials evaluated the efficacy and safety of TXA in liver resection and transplantation. Method A comprehensive search of Medline, Embase, CENTRAL and Clinicaltrials.gov databases was undertaken to identify studies from January 1947 to September 2021. The outcomes of the need for blood transfusion, thromboembolic events and mortality were extracted from the included studies. Quantitative pooling of data was based on the random effects model. Results Six studies reporting on 429 patients were included. TXA reduced the need for perioperative blood transfusion in liver resection and transplantation (OR 0.09; 95% CI 0.01 to 0.72). More importantly, TXA did not increase the incidence of thromboembolic events (OR 2.22; 95% CI 0.47 to 10.43) and mortality (OR 0.60; 95% CI 0.13 to 2.76). Conclusion TXA safely reduces the need for blood transfusion in patients undergoing liver resection and transplantation.

A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery

“…However, our results regarding blood loss are similar to those of other meta-analyses regarding plastic aesthetic (Laikhter et al 2022 ; Locketz et al 2020 ) and non-plastic surgeries (Koh et al 2022 ; Masouros et al 2022 ).…”

Tranexamic acid: Beyond antifibrinolysis

“…TXA has also been successfully used in liver surgery. A recent comprehensive analysis of databases involving 429 liver resection and transplantation patients revealed that TXA significantly and safely reduced the need for blood transfusion 22 …”

Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials

“…Superior evidence from several meta-analyses of RCTs has validated the clinical usefulness of prophylactic TXA in reducing perioperative bleeding, transfusion need, hospital stay, and mortality rate. These meta-analyses encompassed an extensive diversity of various operative procedures, including postpartum hemorrhage following Cesarean delivery [ 36 ], hepatic surgery [ 37 ], tonsillectomy [ 38 ], orthopaedic trauma surgery [ 39 ], endoscopic sinus surgery [ 40 ], and total-knee arthroplasty [ 41 ]. Our meta-analysis expands the clinical utility of prophylactic TXA in hysterectomy patients.…”