Hemodynamics, fluids & transfusion
Kidney disease in trials of perioperative tranexamic acid.
Authors' conclusion
The large evidence base supporting perioperative tranexamic acid suffers from broad and unjustified exclusion of patients with kidney disease. Typical perioperative dosing of tranexamic acid is likely safe and effective in patients with creatinine clearance >30 mL/min, but effects in more severe kidney disease are unknown.
Study context
- Population
- Patients undergoing non-obstetric surgery
- Participants
- 53,085 patients · 300 trials
- Comparison
- IV TXA vs placebo or usual care without TXA
- Outcome
- Handling of kidney disease in trials
Pooled result
As reported in the abstract
Participants enrolled in trials explicitly excluding patients with kidney disease
45,958
86.6%
Trials explicitly excluding patients with kidney disease
228
76.0%
Trials adjusting dosing for kidney function
5
Further pooled results
Bleeding by kidney function subgroup (one large noncardiac surgery trial)
- Similar reduction in bleeding across subgroups of kidney function
- Excluded patients with creatinine clearance <30 mL/min
Seizures
- No analysis could be performed regarding seizure risk
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Thrombotic events, eGFR <60 mL/min/1.73m2 (subgroup; 2 large trials)Both trials excluded patients with severe kidney disease | 0.95 (0.83–1.07) | |
| Thrombotic events, eGFR ≥ 60 mL/min/1.73m2 (subgroup; 2 large trials) | 1.00 (0.91–1.11) | |
| 0.512Relative risk (log scale) |
- Thrombotic events, eGFR <60 mL/min/1.73m2 (subgroup; 2 large trials): P for subgroup difference = 0.47
- Thrombotic events, eGFR ≥ 60 mL/min/1.73m2 (subgroup; 2 large trials): P for subgroup difference = 0.47
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →