Cardiothoracic & vascular anesthesia
Hemostatic effects of tranexamic acid in cardiac surgical patients with antiplatelet therapy: a systematic review and meta-analysis
Authors' conclusion
This meta-analysis demonstrated that TXA significantly reduced post-operative blood loss and transfusion requirements for cardiac surgical patients with preoperative APT.
Study context
- Population
- Adult cardiac surgical patients with preoperative antiplatelet therapy (APT)
- Participants
- 3,018 patients · 12 randomized-controlled trials (RCTs)
- Comparison
- Intravenous tranexamic acid (TXA) vs control
- TXAn = 1,510
- Controln = 1,508reference
- Outcome
- Post-operative blood loss
Methodological detailssubgroup analyses, meta-regression
- Subgroup analyses
- Meta-regression
Pooled result
As reported in the abstract
Post-operative blood loss, by APT type
MD
- 0.38 L
95% CI - 0.73 to - 0.03P = 0.03
Dual antiplatelet therapy (DAPT)
MD
- 0.26 L
95% CI - 0.28 to - 0.24P < 0.00001
aspirin
MD
- 0.37 L
95% CI - 0.63 to - 0.10P = 0.007
clopidogrel
Further pooled results
| Outcome | Estimate |
|---|---|
| Post-operative blood loss (subgroup: DAPT discontinued on day of surgery vs less than 5-7 days preoperatively)TXA vs Control · DAPT discontinued on the day of surgery | MD - 1.23 L (95% CI - 1.42 to - 1.04) |
| Post-operative blood loss (subgroup: DAPT discontinued on day of surgery vs less than 5-7 days preoperatively)TXA vs Control · DAPT discontinued less than 5-7 days preoperatively | MD - 0.16 L (95% CI - 0.27 to - 0.05) |
| RBC transfusion (subgroup: DAPT discontinued on day of surgery vs less than 5-7 days preoperatively)TXA vs Control · DAPT discontinued on the day of surgery | MD - 3.90 units (95% CI - 4.75 to - 3.05) |
| RBC transfusion (subgroup: DAPT discontinued on day of surgery vs less than 5-7 days preoperatively)TXA vs Control · DAPT discontinued less than 5-7 days preoperatively | MD - 1.03 units (95% CI - 1.96 to - 0.10) |
- Post-operative blood loss (subgroup: DAPT discontinued on day of surgery vs less than 5-7 days preoperatively): P < 0.00001 for subgroup difference
- RBC transfusion (subgroup: DAPT discontinued on day of surgery vs less than 5-7 days preoperatively): P < 0.00001 for subgroup difference
Reoperation for bleeding
- Significantly lower incidence in TXA vs Control
Post-operative RBC and fresh-frozen plasma (FFP) transfusion
- Significantly lower in TXA vs Control
Original publication
Hemostatic effects of tranexamic acid in cardiac surgical patients with antiplatelet therapy: a systematic review and meta-analysis. Perioper Med (Lond). Published 17 June 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →