Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis.
OBJECTIVE
Tranexamic acid reduces blood loss and transfusion in on-pump coronary artery bypass graft (CABG) surgery. Compared with on-pump, off-pump surgery is associated with less blood loss and transfusion. Therefore, tranexamic acid may be less effective for off-pump surgery, and its safety profile may be different in this setting. The aim of this study was to determine the efficacy and safety of tranexamic acid for off-pump CABG surgery.


METHODS
Systematic review and meta-analysis.


METHODS
University of Edinburgh.


METHODS
The administration of tranexamic acid.


METHODS
A systematic review of randomized controlled trials administering tranexamic acid to patients undergoing off-pump CABG surgery. A meta-analysis of 24-hour blood loss, postoperative allogeneic transfusion, and thromboembolic events.


RESULTS
Eight trials were identified. The lack of appropriate data limited the meta-analysis on blood loss. Tranexamic acid significantly reduced the overall risk of allogeneic blood component transfusion (risk ratio = 0.47; 95% confidence intervals, 0.33-0.66; p < 0.0001) and packed red blood cell transfusions (risk ratio = 0.51; 95% CI, 0.36-0.71; p = 0.0001). No association was found between tranexamic acid and myocardial infarction, stroke, or pulmonary embolism. Population sizes of meta-analyses ranged from 466 to 544.


CONCLUSIONS
Tranexamic acid reduces blood transfusion after off-pump surgery. Although no association with adverse events was found, the population sample size was too small to detect rare but clinically significant adverse events. A well-designed randomized controlled trial with an appropriate sample size is required to confirm tranexamic acid effectiveness and safety in off-pump CABG surgery.
University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, United Kingdom. s.c.a.ma@sms.ed.ac.uk
S C
SC
Adler Ma
William
W
Brindle
Gillian
G
Burton
Stuart
S
Gallacher
Fong Cheng
FC
Hong
Ilinda
I
Manelius
Andrew
A
Smith
Weiyang
W
Ho
R Peter
RP
Alston
Kausik
K
Bhattacharya
D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D057725:Operative Blood Salvage; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology; D011517:Prothrombin Time; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018570:Risk Assessment; D013923:Thromboembolism / Q000453:epidemiology; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid