The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis

Montroy, Joshua; Hutton, Brian; Moodley, Preveshen; Fergusson, Nicholas A; Cheng, Wei; Tinmouth, Alan; Lavallée, Luke T.; Fergusson, Dean; Breau, Rodney H.

doi:10.1016/j.tmrv.2018.02.003

Cited by 83 publications

(58 citation statements)

References 70 publications

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“…Topical use of TXA may provide a high drug concentration on the wound surface with negligible systemic concentrations. Topical use is still off‐label, with no consensus regarding the optimal TXA concentration in the solution applied, mode of application or duration of contact. Most publications come from joint replacement surgery, where instilling TXA as a bolus into the joint reduces bleeding equivalent to that following intravenous administration.…”

Section: Introductionmentioning

confidence: 99%

Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial

et al. 2019

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Background Topical administration of tranexamic acid (TXA) may be an alternative to intravenous administration to reduce bleeding with a lower risk of systemic adverse events. The aim of this study was to investigate whether moistening a surgical wound with TXA before closure, leaving a thin film of drug only, would reduce postoperative bleeding. Methods This was a two‐centre, stratified, parallel‐group, placebo‐controlled, double‐blind RCT. Patients undergoing mastectomy with or without axillary lymph node clearance were randomized 1 : 1 to moistening of wound surface before closure with either 25 mg/ml TXA or 0·9 per cent sodium chloride (placebo). The primary endpoint was postoperative bleeding as measured by drain production in the first 24 h. Secondary endpoints were early haematoma, total drain production, postoperative complications and late aspirations of seroma within 3 months. Results Between 1 January 2016 and 31 August 2018, 208 patients were randomized. Two patients were converted to a different surgical procedure at surgery, and four did not receive the intervention owing to technical error. Thus, 202 patients were included in the study (101 in the TXA and 101 in the placebo group). TXA reduced mean drain production at 24 h (110 versus 144 ml; mean difference 34 (95 per cent c.i. 8 to 60) ml, P = 0·011). One patient in the TXA group had early haematoma compared with seven in the placebo group (odds ratio (OR) 0·13 (95 per cent c.i. 0·02 to 1·07); P = 0·057). There was no significant difference in postoperative complications between TXA and placebo (13 versus 10; OR 1·11 (0·45 to 2·73), P = 0·824) or need for late seroma aspirations (79 versus 67 per cent; OR 1·83 (0·91 to 3·68), P = 0·089). Conclusion Moistening the wound with TXA 25 mg/ml before closure reduces postoperative bleeding within the first 24 h in patients undergoing mastectomy. Registration number: NCT02627560 (https://clinicaltrials.gov).

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Section: Introductionmentioning

confidence: 99%

Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial

et al. 2019

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“…In the United States (U.S.), blood transfusion rates have steadily declined over 30% in the past decade . Several factors have contributed to this decline, including the availability of revised clinical guidelines, implementation of patient blood management programs, an expanded repertoire of marrow‐sparing and hemostatic agents, and an increase in the practice of minimally invasive surgeries . Despite these advancements, blood transfusion remains common in U.S. hospitals …”

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confidence: 99%

Sociodemographic and behavioral characteristics associated with blood donation in the United States: a population‐based study

et al. 2019

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BACKGROUND Contemporary population‐based data on characteristics associated with blood donation in the United States (U.S.) are limited. STUDY DESIGN AND METHODS A cross‐sectional analysis was performed among 28,739 persons aged 18 years and older who participated in the 2016 National Health Interview Survey, a household survey of the noninstitutionalized U.S. civilian population. Analyses were weighted and accounted for the complex survey design. Adjusted prevalence ratios (aPR) were estimated by multivariable log‐binomial regression. RESULTS The percentage of individuals reporting a past‐year history of blood donation was 5.7% (95% confidence interval [CI], 5.3%‐6.1%) and was highest in the youngest age group (18‐24 years, 8.4%). A past‐year history of blood donation was more common in males compared to females (6.3% vs. 5.1%; aPR, 1.12 [95% CI, 0.99‐1.27]) and those born in the U.S. compared to individuals born outside the U.S. (6.4% vs. 2.4%; aPR, 1.92 [95% CI, 1.49‐2.47]). The percentage of individuals with a past‐year history of blood donation was significantly lower in blacks (3.9%; aPR, 0.60 [95% CI, 0.47‐0.75]) and Hispanics (3.0%; aPR, 0.63 [95% CI, 0.48‐0.83]) in comparison to whites (6.9%). Being a college graduate, being employed, being physically active, and never being a cigarette smoker were factors positively associated with blood donation. The percentage of individuals with a past‐year history of blood donation varied by geographic census region, with prevalence being higher in the Midwest (7.3%) and South (6.0%) compared to the Northeast (4.7%) and West (4.4%). CONCLUSION Continued differences in the blood donor population with reference to the U.S. population underscore the need to understand barriers or deterrents to blood donation. Evidence‐based donor recruitment and related policies remain imperative to ensure that there is a sustainable blood supply.

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“…Antifibrinolytic use may reduce blood loss in cardiac surgery, trauma, orthopedic surgery, liver surgery and solid organ transplantation, obstetrics and gynecology, and neurosurgical interventions. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Systemic tranexamic acid promotes bone healing in a rat model of femur fracture

et al. 2020

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Objectives This study aims to investigate the effect of tranexamic acid (TXA) on the union of closed femoral fractures using radiological and histological methods in an experimental rat model. Materials and methods This experimental study was conducted between June 2017 and February 2018. Closed femoral fractures were created in 36 male Wistar albino rats (age: three months [range, 2.5-3.5 months], weighing 200 grams [range, 180-220 grams]). Half of the animals randomly divided into two groups were administered intravenous single dose of TXA (30 mg/kg), whereas the animals in the control group did not receive any medication. The animals in the two groups were randomly divided into three groups with six animals each and cervical dislocation was performed at days 15, 30, and 45, and radiological and histopathological healing scores were compared. Results When the mean radiological scores of the TXA and control groups were compared, a statistically significant difference was found in favor of the TXA group at day 15 (p=0.019), but no significant difference was found in the mean scores on days 30 and 45 (p=0.138 and p=0.269, respectively). Histopathological examination also showed a statistically significant difference between the 15-day mean score values in favor of the TXA group ( p = 0. 017 ). Conclusion The use of systemic TXA accelerates early bone formation and fracture healing.

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The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis

Cited by 83 publications

References 70 publications

Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial

Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial

Sociodemographic and behavioral characteristics associated with blood donation in the United States: a population‐based study

Systemic tranexamic acid promotes bone healing in a rat model of femur fracture

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