Cor Vasa 2013, 55(2):e184-e189 | DOI: 10.1016/j.crvasa.2012.10.002

Topical use of tranexamic acid in cardiac surgery - a review and meta-analysis of four randomized controlled trials

Tomáš Vaněk^*, Zbyněk Straka

Kardiochirurgická klinika, Kardiocentrum 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha, Česká republika

The article deals with the issue of topical use of tranexamic acid in cardiac surgery. Four randomized, double--blind trials comparing tranexamic acid vs. placebo were identified in the available literature (371 patients in total). In all of these studies the topical application of tranexamic acid significantly reduced postoperative blood loss, whereas a significant reduction of transfusion requirements was only described in one of these studies. A meta-analytic approach confirmed a significant reduction in blood loss (in 24 hours) by 321.6 mL on average (95% confidence interval -530.3 mL, -112.9 mL; p = 0.003). Another trial was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application. Despite an evident tendency towards lower blood loss in the group treated also topically, the differences between groups in this study did not reach statistical significance. There is an apparent need for further controlled trials with larger groups of patients.

Keywords: Cardiac surgery; Fibrinolysis; Fibrinolytic inhibitors; Meta-analysis; Topical application; Tranexamic acid

Received: August 24, 2012; Revised: October 19, 2012; Accepted: October 20, 2012; Published: April 1, 2013  Show citation