The effect of tranexamic acid to reduce blood loss and transfusion on off-pump coronary artery bypass surgery: A systematic review and cumulative meta-analysis

Dai, Zhao; H, Chu; Wang, Shiduan; Liang, Yongxin

doi:10.1016/j.jclinane.2017.10.004

Cited by 37 publications

(26 citation statements)

References 27 publications

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“…Considering all surgical procedures, tranexamic acid has been shown to reduce blood loss by approximately one‐third. It has been shown specifically to reduce blood loss, and the rate of allogeneic blood transfusions after coronary artery surgery, spinal surgery, orthopaedic fracture surgery, prostate surgery, caesarean section or hysterectomy and plastic surgery procedures.…”

Section: Surgical Strategiesmentioning

confidence: 99%

Strategies to minimize intraoperative blood loss during major surgery

Shah

Palmer

Klein

2020

British Journal of Surgery

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Background Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative blood conservation strategies. Methods This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient. Results Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays. Conclusion Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high‐quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.

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Section: Surgical Strategiesmentioning

confidence: 99%

Strategies to minimize intraoperative blood loss during major surgery

Shah

Palmer

Klein

2020

British Journal of Surgery

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“…84 It has been shown that OPCAB reduces perioperative blood transfusion, 42,81 and the use of tranexamic acid has been found to reduce the need for postoperative packed red blood cell and fresh frozen plasma transfusion. 85 However, several recent randomized controlled trials have reported increased 5-year mortality for OPCAB on long-term follow-up. 17,83,86,87 This likely is owing to the worse long-term graft patency with increased rates of graft occlusion and the need for subsequent revascularization in OPCAB patients.…”

Section: Postoperative Managementmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting: Closing the Communication Gap Across the Ether Screen

Bianco

Kilic

Gelzinis

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Several meta-analyses have been conducted, but they did not include recent large randomised controlled trials (RCTs)20 or comprehensively looked at both efficacy and harm. Furthermore, one of these reviews grouped tranexamic acid with aprotinin and aminocaproic acid28 while the most recent meta-analysis studied the effect in patients undergoing coronary artery bypass grafting (CABG) without the use of cardiopulmonary bypass 29…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid in cardiac surgery: a systematic review and meta-analysis (protocol)

et al. 2019

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IntroductionBleeding during cardiac surgery is associated with increased morbidity and mortality. Tranexamic acid is an antifibrinolytic with proven efficacy in major surgeries. Current clinical practice guidelines recommend intraoperative use in cardiac procedures. However, several complications have been reported with tranexamic acid including seizures. This review intends to summarise the evidence examining the efficacy and safety of tranexamic acid in patients undergoing cardiac surgery.Methods/designWe will search MEDLINE, Embase, PubMED, ACPJC, CINAHL and the Cochrane trial registry for eligible randomised controlled trials, the search dates for all databases will be from inception until 1 January 2019, investigating the perioperative use of topical and/or intravenous tranexamic acid as a stand-alone antifibrinolytic agent compared with placebo in patients undergoing open cardiac surgery. We categorised outcomes as patient critical or patient important. Selected patient-critical outcomes are: mortality (intensive care unit, hospital and 30-day endpoints), reoperation within 24 hours, postoperative bleeding requiring transfusion of packed red blood cells, myocardial infarction, stroke, pulmonary embolism, bowel infarction, upper or lower limb deep vein thrombosis and seizures. Those outcomes, we perceived as clinical experts to be most patient valued and patients were not involved in outcomes selection process. We will not apply publication date, language, journal or methodological quality restrictions. Two reviewers will independently screen and identify eligible studies using predefined eligibility criteria and then review full reports of all potentially relevant citations. A third reviewer will resolve disagreements if consensus cannot be achieved. We will present the results as relative risk with 95% CIs for dichotomous outcomes and as mean difference or standardised mean difference for continuous outcomes with 95% CIs. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publicationTrial registration numberCRD42018105904

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The effect of tranexamic acid to reduce blood loss and transfusion on off-pump coronary artery bypass surgery: A systematic review and cumulative meta-analysis

Cited by 37 publications

References 27 publications

Strategies to minimize intraoperative blood loss during major surgery

Strategies to minimize intraoperative blood loss during major surgery

Off-Pump Coronary Artery Bypass Grafting: Closing the Communication Gap Across the Ether Screen

Tranexamic acid in cardiac surgery: a systematic review and meta-analysis (protocol)

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