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Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis

To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients.

Journal Title: BMJ : British Medical Journal 20 May 2012, Vol.344
Main Author: Ker, Katharine
Other Authors: Edwards, Phil , Perel, Pablo , Shakur, Haleema , Roberts, Ian
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: British Medical Journal Publishing Group
ID: E-ISSN: 1756-1833 ; DOI: 10.1136/bmj.e3054 ; PMID: 22611164
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recordid: bmj_journals10.1136/bmj.e3054
title: Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis
format: Article
creator:
  • Ker, Katharine
  • Edwards, Phil
  • Perel, Pablo
  • Shakur, Haleema
  • Roberts, Ian
subjects:
  • Medicine
ispartof: BMJ : British Medical Journal, 20 May 2012, Vol.344
description: To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients.
language: eng
source:
identifier: E-ISSN: 1756-1833 ; DOI: 10.1136/bmj.e3054 ; PMID: 22611164
fulltext: fulltext_linktorsrc
issn:
  • 17561833
  • 1756-1833
url: Link


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0To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients.
1Systematic review and meta-analysis.
2Cochrane central register of controlled trials, Medline, and Embase, from inception to September 2011, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of relevant articles.
3Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in surgical patients. Outcome measures of interest were the number of patients receiving a blood transfusion; the number of patients with a thromboembolic event (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism); and the number of deaths. Trials were included irrespective of language or publication status.
4129 trials, totalling 10 488 patients, carried out between 1972 and 2011 were included. Tranexamic acid reduced the probability of receiving a blood transfusion by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65; P<0.001). This effect remained when the analysis was restricted to trials using adequate allocation concealment (0.68, 0.62 to 0.74; P<0.001). The effect of tranexamic acid on myocardial infarction (0.68, 0.43 to 1.09; P=0.11), stroke (1.14, 0.65 to 2.00; P=0.65), deep vein thrombosis (0.86, 0.53 to 1.39; P=0.54), and pulmonary embolism (0.61, 0.25 to 1.47; P=0.27) was uncertain. Fewer deaths occurred in the tranexamic acid group (0.61, 0.38 to 0.98; P=0.04), although when the analysis was restricted to trials using adequate concealment there was considerable uncertainty (0.67, 0.33 to 1.34; P=0.25). Cumulative meta-analysis showed that reliable evidence that tranexamic acid reduces the need for transfusion has been available for over 10 years.
5Strong evidence that tranexamic acid reduces blood transfusion in surgery has been available for many years. Further trials on the effect of tranexamic acid on blood transfusion are unlikely to add useful new information. However, the effect of tranexamic acid on thromboembolic events and mortality remains uncertain. Surgical patients should be made aware of this evidence so that they can make an informed choice.
pubBritish Medical Journal Publishing Group
doi10.1136/bmj.e3054
urlhttp://bmj.com/content/344/bmj.e3054.full.pdf
pmid22611164
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issue7858
pagese3054
date2012-05-20