The safety and efficiency of intravenous administration of tranexamic acid in coronary artery bypass grafting (CABG): A meta-analysis of 28 randomized controlled trials

- The safety and efficiency of intravenous administration of tranexamic acid in.
- Background: The safety and efficiency of intravenous administration of tranexamic acid (TXA) in coronary artery bypass grafting (CABG) remains unconfirmed.
- 95% CI and the postoperative chest tube drainage in the first 24 h by 206 ml (95% CI − 248.23 to − 164.15).
- However, it may increase the risk of postoperative seizures..
- Keywords: Coronary artery bypass, Postoperative complications, Tranexamic acid.
- Tranexamic acid (TXA), an antifibrinolytic agent, has been widely used and proved to be effective in reducing risk of blood loss and.
- A systematic and comprehensive search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED and EMBASE from database established to February 8, 2018 with no language limita- tion.
- The search strategy included the following MED- LINE subject heading terms: tranexamic acid and cardiac surgical procedures.
- There are seven do- mains in the Cochrane risk of bias tool, including the random sequence generation, allocation concealment, blinding of participants and personnel, blinding of out- come assessment, incomplete outcome data, selective reporting and other bias.
- Italy Off-pump <.
- Denmark On-pump >.
- On-pump Off-pump.
- Off-pump <.
- Off-pump 5.
- On-pump <.
- Risk of bias within studies.
- Publication bias was evaluated by funnel plots in the fol- lowing outcomes: postoperative cerebrovascular acci- dent, reoperation for bleeding, mortality, myocardial infarction, acute renal insufficiency, the frequency of any.
- On-pump/.
- 2 a risk-of-bias summary.
- Sub-analysis in on-pump CABG with 13 trials in- cluded showed no significant increase in the incidence of cerebrovascular accident in patients who received TXA treatment [9/686 vs 10/711, RR P for effect = 0.90, P for heterogeneity = 0.86, I 2 = 0.
- Nine studies with a total of 5939 participants were in- cluded in the sensitive analysis of studies that random- ized not less 100 participants.
- placebo was 5.99 (95% CI which suggested that tranexamic acid would increase the incidence of sei- zures after CABG (Fig.
- Postoperative chest tube drainage in the first 24 h.
- The overall analysis showed that TXA did not signifi- cantly decrease the mortality in patients receiving CABG when compared with placebo [33/3196 deaths in the.
- TXA group vs 41/3218 deaths in the placebo group, RR P for effect = 0.38, P for heterogen- eity = 0.82, I 2 = 0%, with 18 trails included] (Fig.
- Sub-analysis in the settings of on-pump CABG also showed no statistically significant effect of TXA on mor- tality [6/639 vs 7/663, RR P for ef- fect = 0.88, P for heterogeneity = 0.62, I 2 = 0%, with 12 trials included].
- Sub-analysis in the settings of off-pump included 5 trials, but only one of them reported one pa- tient died in each group (Fig.
- Thirteen studies with 1286 participants were included in the sub-analysis of on-pump CABG, the result of meta-analysis suggested no significant difference of myo- cardial infarction between TXA and placebo [21/639 vs.
- A similar result was found in the sub-analysis in off-pump CABG [RR P for effect = 0.76, P for hetero- geneity = 0.52, I 2 = 0%] (Fig.
- In the subgroup of patients undergoing on-pump CABG, TXA also reduced the transfusion of any blood products, however, this effect was not statistically signifi- cant [RR P for effect = 0.05, P for het- erogeneity<.
- In the sensitivity analysis that included all the studies that randomized more than 99 participants, TXA signifi- cantly decreased the transfusion of any blood products [RR P for effect<.
- In total, 16 studies with 6247 participants were included in the meta-analysis of postoperative chest tube drainage in the first 24 h.
- We treated these two sets of data as two separate studies in the meta-analysis..
- Sub-analysis in the settings of on-pump CABG with 8 trials included showed no significant decrease of chest tube drainage in the first 24 h in patients who received TXA treatment [MD CI.
- A similar result was found in the sub-analysis in off-pump CABG [MD CI.
- Seven studies with a total of 5674 participants were in- cluded in the sensitive analysis.
- The conclusion that TXA would decrease chest tube drainage in the first 24 h was strengthened by the sensitivity analysis [MD.
- In general, the overall quality of evidence in the meta-analyses of postoperative sei- zures and reoperation for bleeding was high.
- However, the overall quality of evidence in the meta-analyses of postoperative transfusion of any blood products and chest tube drainage in the first 24 h was very low due to the problems of inconsistency and the risk of bias.
- However, meta-analysis could not be performed in the sub-analyses of postoperative reoperation for bleeding, mortality and cerebrovascular accident in off- pump CABG due to the small number of incidence.
- A previous meta-analysis suggested that TXA.
- Moreover, the sub-analyses in the different conditions under which GABG was conducted further strengthened the above results.
- In addition, the sensitivity ana- lyses in studies randomized more than 99 participants further strengthened the conclusion that TXA reduced the incidence of reoperation for bleeding, transfusion of any blood products and 24-h blood loss suggesting that the small sample size studies included in the meta-.
- 10 Forest plot of chest tube drainage in the first 24 h.
- Tranexamic acid versus placebo.
- The mean postoperative chest tube drainage in the first 24 h in the intervention groups was 206.19 lower (248.23 to 164.15 lower).
- High quality: Further research is very unlikely to change our confidence in the estimate of effect.
- b 4 studies with a high risk of bias were included.
- e 5 studies with a high risk of bias were included.
- i 2 studies with a high risk of bias were included.
- In the sub-analysis of on-pump GABG, TXA tended to reduce the incidence of reopera- tion for bleeding.
- The exclusion of the study with the largest number of participants due to mixed surgical types in the sub-analysis may explain this difference..
- In the current meta-analysis, enough population were included in the above analyses to detect clinically significant dif- ference.
- In the current meta-analysis we found that TXA increased the incidence of postoperative seizures in CABG surgery..
- Therefore, studies that investigate the optimize dose and regime for administration of TXA are needed in the fu- ture.
- Moreover, a growing number of studies that inves- tigate the efficacy and safety of topical use of tranexamic acid have been conducted in recent years due to the promise of reducing postoperative bleeding and seizures [52, 53].
- A recent meta-analysis showed that the topical application of TXA effectively reduces both transfusion risk and blood loss compared to placebo and no major differences were found between topical and intravenous tranexamic acid with respect to safety and efficacy [54]..
- While in our study, we focused on the safety and efficiency of intravenous administration of tranexamic acid in coronary artery bypass grafting (CABG)..
- Funnel plot of chest tube drainage in the first 24 h (PNG 5 kb).
- TXA: Tranexamic acid.
- YTZ, GC and HYZ were involved in the study design, data review, data analysis, writing paper, review and approval of final manuscript.
- Does tranexamic acid reduce blood loss in off-pump coronary artery bypass? Asian Cardiovasc Thorac Ann..
- Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: comparison between on-pump and off-pump techniques.
- Lessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies.
- High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients.
- Cerebral blood flow in patients with a subarachnoid haemorrhage during treatment with tranexamic acid..
- Tranexamic acid in patients undergoing coronary-artery surgery.
- Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis.
- Effect of tranexamic acid on transfusion requirement in dual antiplatelet-treated anemic patients undergoing off- pump coronary artery bypass graft surgery.
- A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery.
- Tranexamic acid reduces blood transfusions in elderly patients undergoing combined aortic valve and coronary artery bypass graft surgery: a randomized controlled trial.
- The effects of tranexamic acid on postoperative bleeding in coronary artery bypass graft surgery.
- Evaluation and comparison of using low-dose aprotinin and tranexamic acid in CABG: a double blind randomized clinical trial.
- Tranexamic acid reduces blood loss after off- pump coronary surgery: a prospective, randomized, double-blind, placebo- controlled study.
- Low dose tranexamic acid effect on post-coronary artery bypass grafting bleeding.
- Tranexamic acid in on-pump coronary artery bypass grafting without clopidogrel and aspirin cessation: randomized trial and 1-year follow-up.
- The effects of tranexamic acid and 6%.
- Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass operations: a double-blind, randomized, placebo-controlled trial.
- The use of low-dose aprotinin, epsilon-aminocaproic acid or tranexamic acid for prevention of mediastinal bleeding in patients receiving aspirin before coronary artery bypass operations.
- Prophylactic tranexamic acid and epsilon-aminocaproic acid for primary myocardial revascularization.
- Tranexamic acid in off-pump coronary surgery: a preliminary, randomized, double-blind, placebo-controlled study..
- Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization.
- Tranexamic acid reduces bleeding after off-pump coronary artery bypass grafting.
- Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin until surgery.
- Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass.
- Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: a prospective randomized controlled clinical trial.
- A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting.
- Tranexamic acid reduces postoperative bleeding in off-pump coronary artery bypass grafting.
- Tranexamic acid and primary coronary artery bypass surgery: a prospective study.
- Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery.
- Evaluation and comparison of use of low-dose aprotinin and tranexamic acid in CABG: a double-blind, prospective, randomized study of 150 patients.
- Safety and efficacy of caproamin fides and tranexamic acid versus placebo in patients undergoing coronary artery revascularization.
- Tranexamic acid-associated seizures: a meta-analysis.
- Tranexamic acid concentrations associated with human seizures inhibit glycine receptors.
- Tranexamic acid impairs gamma- aminobutyric acid receptor type A-mediated synaptic transmission in the murine amygdala: a potential mechanism for drug-induced seizures?.
- Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors.
- High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement.
- Does topical tranexamic acid reduce postcoronary artery bypass graft bleeding? J Res Med Sci.
- Topical application of tranexamic acid reduces postoperative bleeding in open-heart surgery: myth or fact? J Coll Physicians Surg Pak.
- The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis

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