• J. Cardiothorac. Vasc. Anesth. · Feb 2011

    Review Meta Analysis

    Tranexamic acid is associated with less blood transfusion in off-pump coronary artery bypass graft surgery: a systematic review and meta-analysis.

    • S C Adler Ma, William Brindle, Gillian Burton, Stuart Gallacher, Fong Cheng Hong, Ilinda Manelius, Andrew Smith, Weiyang Ho, R Peter Alston, and Kausik Bhattacharya.
    • University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, United Kingdom. s.c.a.ma@sms.ed.ac.uk
    • J. Cardiothorac. Vasc. Anesth. 2011 Feb 1;25(1):26-35.

    ObjectiveTranexamic acid reduces blood loss and transfusion in on-pump coronary artery bypass graft (CABG) surgery. Compared with on-pump, off-pump surgery is associated with less blood loss and transfusion. Therefore, tranexamic acid may be less effective for off-pump surgery, and its safety profile may be different in this setting. The aim of this study was to determine the efficacy and safety of tranexamic acid for off-pump CABG surgery.DesignSystematic review and meta-analysis.SettingUniversity of Edinburgh.InterventionsThe administration of tranexamic acid.MethodsA systematic review of randomized controlled trials administering tranexamic acid to patients undergoing off-pump CABG surgery. A meta-analysis of 24-hour blood loss, postoperative allogeneic transfusion, and thromboembolic events.Measurements And Main ResultsEight trials were identified. The lack of appropriate data limited the meta-analysis on blood loss. Tranexamic acid significantly reduced the overall risk of allogeneic blood component transfusion (risk ratio = 0.47; 95% confidence intervals, 0.33-0.66; p < 0.0001) and packed red blood cell transfusions (risk ratio = 0.51; 95% CI, 0.36-0.71; p = 0.0001). No association was found between tranexamic acid and myocardial infarction, stroke, or pulmonary embolism. Population sizes of meta-analyses ranged from 466 to 544.ConclusionsTranexamic acid reduces blood transfusion after off-pump surgery. Although no association with adverse events was found, the population sample size was too small to detect rare but clinically significant adverse events. A well-designed randomized controlled trial with an appropriate sample size is required to confirm tranexamic acid effectiveness and safety in off-pump CABG surgery.Copyright © 2011 Elsevier Inc. All rights reserved.

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