Effect of Tranexamic Acid on the Reduction of Blood Loss in Craniosynostosis Surgery: A Systematic Review and Meta-analysis

Abstract

Background: Although many published studies have investigated the benefits of tranexamic acid (TXA) in reducing perioperative bleeding, no large meta-analysis has been conducted to demonstrate its overall benefit. Methods: A systematic review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Cochrane, Ovid, Embase, Web of Science, ClinicalTraisl.Gov, and Scopus databases were searched for articles reporting the benefit of TXA in reducing perioperative bleeding in craniosynostosis surgery from establishment through October 2022. The results of our meta-analysis were pooled across the studies using a random-effects model, and presented as a weighted mean difference with 95% confidence interval (95% CI). Results: The database search yielded 3207 articles, of which 27 studies with a corresponding number of 9696 operations were eligible. The meta-analysis included only 18 studies, accounting for 1564 operations. Of those operations, 882 patients received systemic TXA, whereas 682 patients received placebo (normal saline), no intervention, low dose TXA, or other control substances. This meta-analysis demonstrated a significant beneficial effect of TXA in reducing perioperative bleeding, particularly when compared with other controlled substances, with a weighted mean difference of −3.97 (95% CI = −5.29 to −2.28). Conclusions: To our knowledge, this is the largest meta-analysis in the literature investigating the benefit of TXA in reducing perioperative blood loss in craniosynostosis surgery. We encourage implementing TXA-protocol systems in hospitals after the appraisal of the data presented in this study.

Effectiveness of Tranexamic Acid in Trauma Patients: A Systematic Review

“…Conversely, another study emphasized the ongoing investigation into the optimal dosing and timing of TXA administration in non-trauma surgical populations, indicating the lack of conclusive evidence in this patient group [8]. These findings echo those of other reports in the literature, suggesting that the debate on TXA's benefits in trauma injury surgeries remains unresolved [9,10]. These divergences emphasize the imperative for a comprehensive systematic review to amalgamate available evidence, address methodological variations, and offer a nuanced understanding of TXA's overall impact on this patient population.…”