Anti-inflammatory effect of tranexamic acid on adult cardiac surgical patients: A PRISMA-compliant systematic review and meta-analysis

Abstract

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.

A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery

“…The application of TXA for hemostatic purposes in orthopaedic (Groene et al 2021 ; Wong et al 2021 ; Goldstein et al 2022 ), oncological (Fowler et al 2022 ; Liechti et al 2022 ), and cardiac surgery (Houston et al 2020 ; Chunmei et al 2022 ) is well documented. However, the use of TXA in aesthetic plastic surgery remains controversial due to the scarcity and quality of the studies and the wide range of aesthetic plastic surgery procedures.…”

“…Although it has been approved by the US Food and Drug Administration (FDA) for the treatment of haemophilia, studies are ongoing investigations of its prescription for other medical uses. Despite its use in The application of TXA for hemostatic purposes in orthopaedic (Groene et al 2021;Wong et al 2021;Goldstein et al 2022), oncological (Fowler et al 2022;Liechti et al 2022), and cardiac surgery (Houston et al 2020;Chunmei et al 2022) is well documented.…”

The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center

“…Consistent with that, a recent meta-analysis by us evaluating the effect of TXA on inflammatory biomarkers in adult cardiac surgical patients, demonstrated that TXA has significant anti-inflammatory effects as manifested by reduction of multiple pro-inflammatory mediators (e.g., IL-6, tumor necrosis factor-α, IL-1β, PMNE). [78] There are several limitations worth to be mentioned. Firstly, most data of the present study were homogeneous due to similar investigators, clinical care protocols and outcome definitions.…”

“…Consistent with that, a recent meta-analysis by us evaluating the effect of TXA on inflammatory biomarkers in adult cardiac surgical patients, demonstrated that TXA has significant anti-inflammatory effects as manifested by reduction of multiple pro-inflammatory mediators (e.g., IL-6, tumor necrosis factor-α, IL-1β, PMNE). [ 78 ]…”

Tranexamic acid for haemostasis and beyond: does dose matter?

“…Draxler and colleagues have also shown that TXA reduces baseline IL-6, TNF-α, INF-γ and IL-10 levels in the blood of healthy subjects administered TXA [ 76 ]. A recent systematic review and meta-analysis further highlights the anti-inflammatory effects of TXA in cardiac surgery patients [ 78 ].…”