Abstract
Background This meta-analysis was conducted to investigate the evidence for the efficacy and
safety of intrapericardial tranexamic acid (TXA) in cardiac surgery.
Methods We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared
intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials
that focused on chest tube drainage measured during the first 24 hours after surgery
as a primary outcome. We also examined the secondary outcome measures of these trials
such as the incidence of transfusion requirements following surgery and the evidence
for any increase in complication rates.
Results A total of seven randomized controlled trials (six on-pump and one off-pump) comparing
topical application of TXA to placebo in 692 patients were eligible for the blood
loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients
as controls. The use of intrapericardial TXA was associated with a considerable reduction
in 24-hour blood loss in all seven studies and a weighted mean difference of −343.56
mL (95% confidence interval: −316.41, −370.72) significantly differed from zero (p = 0.005) with a heterogeneity of I
2 = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower
in one study and was not significant but with trend in favor of TXA in five out of
the six studies in which it was reported. In one trial, TXA was not detected in any
patient and in another the studied groups were similar in postoperative complications,
such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation,
seizures, and infections.
Conclusions Findings from this meta-analysis suggest that intrapericardial use of TXA in patients
undergoing cardiac surgery can decrease postoperative bleeding without increasing
the risk of postoperative seizures. Future large randomized, double-blind, controlled
clinical trials are needed to confirm these promising findings.
Keywords
surgery - complications - coronary artery bypass grafting - valve surgery
