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Meta-Analysis
. 2012 May 17:344:e3054.
doi: 10.1136/bmj.e3054.

Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis

Katharine Ker  1 , Phil Edwards, Pablo Perel, Haleema Shakur, Ian Roberts
Affiliations
Meta-Analysis

Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis

Katharine Ker et al. BMJ. .

Abstract

Objective: To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients.

Design: Systematic review and meta-analysis.

Data sources: Cochrane central register of controlled trials, Medline, and Embase, from inception to September 2011, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of relevant articles.

Study selection: Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in surgical patients. Outcome measures of interest were the number of patients receiving a blood transfusion; the number of patients with a thromboembolic event (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism); and the number of deaths. Trials were included irrespective of language or publication status.

Results: 129 trials, totalling 10,488 patients, carried out between 1972 and 2011 were included. Tranexamic acid reduced the probability of receiving a blood transfusion by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65; P<0.001). This effect remained when the analysis was restricted to trials using adequate allocation concealment (0.68, 0.62 to 0.74; P<0.001). The effect of tranexamic acid on myocardial infarction (0.68, 0.43 to 1.09; P = 0.11), stroke (1.14, 0.65 to 2.00; P = 0.65), deep vein thrombosis (0.86, 0.53 to 1.39; P = 0.54), and pulmonary embolism (0.61, 0.25 to 1.47; P=0.27) was uncertain. Fewer deaths occurred in the tranexamic acid group (0.61, 0.38 to 0.98; P = 0.04), although when the analysis was restricted to trials using adequate concealment there was considerable uncertainty (0.67, 0.33 to 1.34; P = 0.25). Cumulative meta-analysis showed that reliable evidence that tranexamic acid reduces the need for transfusion has been available for over 10 years.

Conclusions: Strong evidence that tranexamic acid reduces blood transfusion in surgery has been available for many years. Further trials on the effect of tranexamic acid on blood transfusion are unlikely to add useful new information. However, the effect of tranexamic acid on thromboembolic events and mortality remains uncertain. Surgical patients should be made aware of this evidence so that they can make an informed choice.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Selection of trials for review
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Fig 2 Cumulative meta-analysis of the effect of tranexamic acid in surgery on risk of blood transfusion in adequately concealed trials
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Fig 3 Cumulative meta-analysis of the effect of tranexamic acid in surgery on risk of myocardial infarction in adequately concealed trials
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Fig 4 Cumulative meta-analysis of the effect of tranexamic acid in surgery on risk of death in adequately concealed trials
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Fig 5 Funnel plot with pseudo 95% confidence limits for meta-analysis on effect of tranexamic acid on risk of blood transfusion
See this image and copyright information in PMC

Comment in

References

    1. Crescenti A, Borghi G, Bignami E, Bertarelli G, Landoni G, Casiraghi GM, et al. Intraoperative use of tranexamic acid to reduce transfusion rate in patients undergoing radical retropubic prostatectomy: double blind, randomised, placebo controlled trial. BMJ 2011;343:d5701. - PMC - PubMed
    1. Henry DA, Moxey AJ, Carless PA, O’Connell D, McClelland B, Henderson KM, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2001;1:CD001886. - PubMed
    1. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Wiley, 2008.
    1. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP [program], 2009.
    1. Review Manager (RevMan) [Computer program] Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.

MeSH terms