title: The effects of lysine analogs during pelvic surgery: a systematic review and meta-analysis.
abstract: Pelvic vasculature is complex and inconsistent while pelvic bones impede access to pelvic organs. These anatomical characteristics render pelvic surgery inherently difficult, and some of these procedures are frequently associated with blood loss that necessitates blood transfusion. The aim of this study was to review the literature on the use of lysine analogs to prevent bleeding and blood transfusion during pelvic surgery. The objective of this study was to assess the safety and efficacy of lysine analogs during pelvic surgery. A systematic literature search was performed using Medline, Cochrane Register of Clinical Trials, Embase, and the reference lists of relevant articles. Randomized controlled trials or observational cohort studies comparing a lysine analog to placebo or standard care were included. Outcomes collected were blood transfusion, blood loss, thromboembolic adverse events (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism), nonthromboembolic adverse events, and death. There were no language limitations. Fifty-six articles reported on 68 comparisons between a lysine analog and an inactive comparator, involving a total of 7244 patients published between 1961 and 2013. Thirty-nine studies evaluated urologic procedures, and 21 evaluated gynecologic procedures. Thirty-six studies (60%) were published before 1980. Of the 43 randomized comparisons, only 30 (44%) had a score of 3 or higher on Jadad's 5-point scale of methodological quality. Among randomized trials, lysine analogs reduced the risk of blood transfusion (pooled odds ratio [OR], 0.47; 95% confidence interval [CI], 0.35-0.64) and blood loss (pooled OR, 0.22; 95% CI, 0.18-0.27). There was a small statistically insignificant increased risk of thromboembolic events (pooled OR, 1.07; 95% CI, 0.72-1.59) and no-thrombotic serious adverse events (pooled OR, 1.11; 95% CI, 0.67-1.83). In the 17 randomized trials published since the year 2000, only 6 thrombotic events were reported, 4 of which occurred in the placebo arm. Lysine analogs did not increase risk of death (pooled OR, 0.91; 95% CI, 0.34-2.48). These results are significant as they indicate that lysine analogs significantly reduce blood loss and blood transfusion during pelvic surgery. Although there does not appear to be a large increase in the risk of thromboembolic and nonthrombotic adverse events, more data are required to definitively assess these outcomes. Based on this review, lysine analogs during pelvic surgery seem to reduce bleeding and blood transfusion requirements. Although there does not seem to be a significant risk of adverse effects, larger studies would help clarify risks, if any, associated with lysine analog use.
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada. Electronic address: rbreau@ottawahospital.on.ca.
authors: Rodney H
authors: RH
authors: Breau
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Madzouka B
authors: MB
authors: Kokolo
authors: University of Ottawa, Ottawa, Ontario, Canada.
authors: Nahid
authors: N
authors: Punjani
authors: The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors: Ilias
authors: I
authors: Cagiannos
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Andrew
authors: A
authors: Beck
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Naomi
authors: N
authors: Niznick
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Chieny
authors: C
authors: Buenaventura
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Juthaporn
authors: J
authors: Cowan
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors: Gregory
authors: G
authors: Knoll
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors: Franco
authors: F
authors: Momoli
authors: The Ottawa Hospital, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors: Chris
authors: C
authors: Morash
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Marcel
authors: M
authors: Ruzicka
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Svetlana
authors: S
authors: Schachkina
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Alan
authors: A
authors: Tinmouth
authors: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Hai Yan
authors: HY
authors: Xie
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
authors: Dean A
authors: DA
authors: Fergusson
mesh_terms: D015119:Aminocaproic Acid / Q000737:chemistry; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000379:methods*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008239:Lysine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013514:Surgical Procedures, Operative; D013927:Thrombosis; D014148:Tranexamic Acid / Q000737:chemistry; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
chemical_list: D014148:Tranexamic Acid; D008239:Lysine; D015119:Aminocaproic Acid
keywords: Aminocaproic acid; Pelvis; Surgery; Tranexamic acid