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Meta-Analysis
. 2025 Jan-Dec:31:10760296251342467.
doi: 10.1177/10760296251342467. Epub 2025 May 19.

Tranexamic Acid in Patients Undergoing Liver Resection: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohammad Tanashat  1 , Basma Badrawy Khalefa  2 , AlMothana Manasrah  3 , Husam Abu Suilik  4 , Mohamed Abouzid  5   6 , Wafaa Shehada  7 , Ahmed Almasry  8 , Ibrar Atiq  9 , Mohamed Abuelazm  8
Affiliations
Meta-Analysis

Tranexamic Acid in Patients Undergoing Liver Resection: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohammad Tanashat et al. Clin Appl Thromb Hemost. 2025 Jan-Dec.

Abstract

BackgroundTranexamic acid (TA), a synthetic lysine derivative, is known for its antifibrinolytic effect and potential to reduce bleeding in surgeries like arthroplasty, cardio-aortic procedures, and liver transplantation. This meta-analysis seeks to provide robust clinical evidence on TA's effectiveness in reducing blood loss and transfusion needs during orthotopic liver transplantation.MethodsThe systematic review and meta-analysis included the relevant randomized controlled trials (RCTs) retrieved from PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS databases until August 2024. The meta-analysis was done using (RevMan 5.4.1). PROSPERO ID: CRD42024589151.ResultsOur meta-analysis of seven RCTs with 1875 patients found no significant differences between TA and control groups in total red blood cell units transfused (MD: -3.74 units; 95% CI [-8.49, 1.01]; P = .12), perioperative transfusions (MD: -0.42 units; 95% CI [-3.17, 2.32]; P = .76), or overall blood loss (MD: -167.81 mL; 95% CI [-415.29, 79.67]; P = .18).For safety outcomes, TA was associated with a higher rate of venous thromboembolism events (RR: 1.71; 95% CI [1.01, 2.87]; P = .05; event rate: 4.89% vs 2.91%), while no significant differences were found in other surgical complications (RR: 1.12; 95% CI [0.92, 1.37]; P = .26).ConclusionTA does not reduce blood loss or the need for postoperative transfusions in orthotopic liver transplantation and may raise thrombotic risk. Caution is required to interpret these results due to variations in the study/hospital-specific transfusion protocol details. Larger studies are needed to confirm these findings, and future research should explore the effects of multiple dosing regimens on blood loss and transfusion requirements.

Keywords: liver resection; meta-analysis; tranexamic acid.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA Flow Chart of the Screening Process.
Figure 2.
Figure 2.
Quality Assessment of Risk of Bias in the Included Trials. A Schematic Representation of Risks (Low = Red, Unclear = Yellow, and High = Red) for Specific Types of Biases of Each of the Studies in the Review.
Figure 3.
Figure 3.
Forest Plot of the Primary Outcomes (A. Postoperative Red Blood Cell Units Transfused, B. Overall Red Blood Cell Units Transfused, C. Perioperative Units Transfused).
Figure 4.
Figure 4.
Forest Plot of the Primary Outcomes (A. Number of Patients Receiving Perioperative Transfusions, B. Postoperative Transfusions, C. Total Intraoperative Plus Postoperative Blood Loss).
Figure 5.
Figure 5.
Forest Plot of the Safety Outcome (A. Rate of Venous Thromboembolism, B. Surgical Complications. C. Postoperative Mortality).
See this image and copyright information in PMC

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