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Meta-Analysis
. 2013 Jul 23;2013(7):CD010562.
doi: 10.1002/14651858.CD010562.pub2.

Topical application of tranexamic acid for the reduction of bleeding

Katharine Ker  1 , Deirdre Beecher, Ian Roberts
Affiliations
Meta-Analysis

Topical application of tranexamic acid for the reduction of bleeding

Katharine Ker et al. Cochrane Database Syst Rev. .

Abstract

Background: Intravenous tranexamic acid reduces bleeding in surgery, however, its effect on the risk of thromboembolic events is uncertain and an increased risk remains a theoretical concern. Because there is less systemic absorption following topical administration, the direct application of tranexamic acid to the bleeding surface has the potential to reduce bleeding with minimal systemic effects.

Objectives: To assess the effects of the topical administration of tranexamic acid in the control of bleeding.

Search methods: We searched the Cochrane Injuries Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library; Ovid MEDLINE®, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid OLDMEDLINE®; Embase Classic + Embase (OvidSP); PubMed and ISI Web of Science (including Science Citation Index Expanded and Social Science Citation Index (SCI-EXPANDED & CPCI-S)). We also searched online trials registers to identify ongoing or unpublished trials. The search was run on the 31st May 2013.

Selection criteria: Randomised controlled trials comparing topical tranexamic acid with no topical tranexamic acid or placebo in bleeding patients.

Data collection and analysis: Two authors examined the titles and abstracts of citations from the electronic databases for eligibility. Two authors extracted the data and assessed the risk of bias for each trial. Outcome measures of interest were blood loss, mortality, thromboembolic events (myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism) and receipt of a blood transfusion.

Main results: We included 29 trials involving 2612 participants. Twenty-eight trials involved patients undergoing surgery and one trial involved patients with epistaxis (nosebleed). Tranexamic acid (TXA) reduced blood loss by 29% (pooled ratio 0.71, 95% confidence interval (CI) 0.69 to 0.72; P < 0.0001). There was uncertainty regarding the effect on death (risk ratio (RR) 0.28, 95% CI 0.06 to 1.34; P = 0.11), myocardial infarction (RR 0.33, 95% CI 0.04 to 3.08; P = 0.33), stroke (RR 0.33, 95% CI 0.01 to 7.96; P = 0.49), deep vein thrombosis (RR 0.69, 95% CI 0.31 to 1.57; P = 0.38) and pulmonary embolism (RR 0.52, 95% CI 0.09 to 3.15; P = 0.48). TXA reduced the risk of receiving a blood transfusion by a relative 45% (RR 0.55, 95% CI 0.55 to 0.46; P < 0.0001). There was substantial statistical heterogeneity between trials for the blood loss and blood transfusion outcomes.

Authors' conclusions: There is reliable evidence that topical application of tranexamic acid reduces bleeding and blood transfusion in surgical patients, however the effect on the risk of thromboembolic events is uncertain. The effects of topical tranexamic acid in patients with bleeding from non-surgical causes has yet to be reliably assessed. Further high-quality trials are warranted to resolve these uncertainties before topical tranexamic acid can be recommended for routine use.

PubMed Disclaimer

Conflict of interest statement

None known

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: 1 Topical TXA versus control, outcome: 1.1 Blood loss.
4
4
Funnel plot of comparison: 1 Topical TXA versus control, outcome: 1.8 Blood transfusion.
5
5
Summary of findings table and GRADE evidence profile: Should topical TXA be used for the reduction of surgical bleeding?
1.1
1.1. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 1 Blood loss.
1.3
1.3. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 3 Mortality.
1.4
1.4. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 4 Myocardial infarction.
1.5
1.5. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 5 Stroke.
1.6
1.6. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 6 Deep vein thrombosis.
1.7
1.7. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 7 Pulmonary embolism.
1.8
1.8. Analysis
Comparison 1 Topical tranexamic acid versus control, Outcome 8 Blood transfusion.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

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References to ongoing studies

NCT01260818 {published data only}
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NCT01683955 {published data only}
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NCT01727843 {published data only}
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