ObjectiveThis study aims to evaluate the anti-inflammatory effect of tranexamic acid (TXA) on adult cardiac surgical patients.MethodsPubMed, Embase, Ovid, Web of Science, CNKI, VIP, and WANFANG databases were systematically searched using the related keywords for cardiac surgical randomized controlled trials (RCTs) published from their inception to February 1, 2022. The primary outcomes were postoperative inflammatory biomarkers levels. The secondary outcomes were postoperative systemic inflammatory response syndrome and other major postoperative outcomes. The odds ratios and/or the weighted mean difference (WMD) with a 95% confidence interval (CI) were used to pool the data.ResultsTen RCTs with 770 adult cardiac surgical patients were included. Compared with placebo, TXA achieved statistically significant inhibition of the postoperative interleukin (IL)-6 level (postoperative 6 h: n = 6 trials; WMD −31.66; 95% CI: −45.90, −17.42; p < 0.0001; I2 = 93%; postoperative 24 h: n =  8 trials; WMD, −44.06; 95% CI: −69.21, −18.91; p = 0.006; I2 = 100%); IL-8 level postoperative 24 h, TNF-α level postoperative 24 h, NE level postoperative 6 h: n = 3 trials; WMD, −36.83; 95% CI: −68.84, −4.83; p = 0.02; I2 = 95%); tissue necrosis factor alpha (TNF-α) level (postoperative 6 h: n = 3 trials; WMD, −7.21; 95% CI: −12.41, −2.01; p = 0.007; I2 = 47%; postoperative 24 h: n = 5 trials; WMD, −10.02; 95% CI: −14.93, −5.12; p < 0.0001; I2 = 94%); and neutrophil elastase (NE) level (postoperative 6 h: n = 3 trials; WMD, −66.93; 95% CI: −111.94, −21.92; p = 0.004; I2 = 86%). However, TXA achieved no statistically significant influence on the postoperative 24 h NE level.ConclusionsTXA had a significant anti-inflammatory effect in adult cardiac surgical patients, as evidenced by the reduction of multiple postoperative proinflammatory biomarkers levels, but these results should be interpreted carefully and cautiously, as only a limited number of studies were included and there was high heterogeneity between them. Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022312919.

Tranexamic acid (TXA) is one of the most commonly used antifibrinolytic agents for surgical patients. However, the effect of TXA on myocardial injury remains controversial. We systemically reviewed literature regarding the effectiveness of TXA on myocardial injury in patients who have undergone a cardiac surgery. We included all randomized controlled trials (RCTs) comparing TXA and control (saline) in cardiac surgical patients. Relevant studies were identified by a comprehensive electronic literature search from database inception to 15 August 2021. A standardized data extraction form was used to collect methodological and outcome variables from each eligible study. We conducted a meta-analysis to estimate the pooled effect size of TXA administration on myocardial injury. In total, eight RCTs were identified, with 292 patients in the TXA group, and 241 patients in saline or control group. The meta-analysis demonstrated that patients in the TXA group had lower levels of CK-MB and cTnI within 24 h postoperatively (CK-MB: P = 0.005; cTnI: P = 0.01), compared with the saline group. No significant difference was found with respect to AST level (P = 0.71) between TXA and saline groups within 24 h postoperatively. TXA administration was found to be associated with less myocardial injury among patients who have undergone cardiac surgery. High-quality randomized controlled trials are warranted to further examine the cardioprotective effects of TXA.