Casares Jonathan A, Jaramillo Arturo P, Nizamudeen Sajidha, Valenzuela Angy, Abdul Samad Sanod Khan, Rincon Gomez Ariana S
Faculty of Medicine, Pontificia Universidad Católica del Ecuador, Quito, ECU.
General Practice, Universidad Estatal de Guayaquil, Machala, ECU.
Cureus. 2024 Jun 25;16(6):e63089. doi: 10.7759/cureus.63089. eCollection 2024 Jun.
Tranexamic acid (TXA), a potent antifibrinolytic agent, is widely used in cardiac surgical procedures worldwide to minimize surgical bleeding and reduce the need for perioperative blood transfusions. However, the use of TXA may increase the risk of coronary artery graft thrombosis, potentially leading to a higher occurrence of late thrombotic events. Some studies have suggested that drugs like TXA, aimed at decreasing bleeding during cardiac surgeries, may be associated with elevated risks of thrombotic complications or mortality. Conversely, the reduced need for blood transfusions could contribute to improved long-term outcomes. Thus, a systematic review and meta-analysis were undertaken to assess the efficacy of TXA in cardiac surgery patients. Searches were conducted in databases including PubMed and PubMed Central. Data were extracted, and their quality was assessed using the Cochrane risk of bias tool for randomized clinical trials (RCTs). A random effects model was used to compute the pooled prevalence and investigate heterogeneity using the I2 statistic. Subgroup analyses differentiated between experimental and placebo groups. Additionally, sensitivity analyses were performed to assess the robustness of the findings, and publication bias was examined. An overall sample size of 12,869 patients was included in the meta-analysis, derived from seven of the 10 selected articles. This pooled sample was used to conduct an analysis of TXA's efficacy in cardiac surgery patients. Subgroup analysis revealed a 95% heterogeneity and indicated a p-value of less than 0.05, favoring TXA over placebo in terms of better outcomes. Our research indicates a statistically significant relationship between the efficacy of TXA and the number of patients undergoing heart surgery. According to our findings, there is a pressing need to enhance this evidence base and conduct larger RCTs to better understand the benefits of using TXA, aiming to maintain a low risk of bleeding after both major and minor heart surgeries.
氨甲环酸（TXA）是一种强效抗纤溶药物，在全球范围内广泛应用于心脏外科手术，以尽量减少手术出血并降低围手术期输血需求。然而，使用TXA可能会增加冠状动脉移植血栓形成的风险，潜在地导致晚期血栓事件的发生率更高。一些研究表明，像TXA这样旨在减少心脏手术期间出血的药物，可能与血栓并发症风险升高或死亡率增加有关。相反，输血需求的减少可能有助于改善长期预后。因此，开展了一项系统评价和荟萃分析，以评估TXA在心脏手术患者中的疗效。在包括PubMed和PubMed Central在内的数据库中进行了检索。提取数据，并使用Cochrane随机临床试验（RCT）偏倚风险工具评估其质量。使用随机效应模型计算合并患病率，并使用I2统计量研究异质性。亚组分析区分了实验组和安慰剂组。此外，进行了敏感性分析以评估研究结果的稳健性，并检查了发表偏倚。荟萃分析纳入了12869例患者的总体样本量，来自10篇选定文章中的7篇。这个合并样本用于分析TXA在心脏手术患者中的疗效。亚组分析显示异质性为95%，p值小于0.05，表明在改善预后方面TXA优于安慰剂。我们的研究表明，TXA的疗效与接受心脏手术的患者数量之间存在统计学上的显著关系。根据我们的研究结果，迫切需要加强这一证据基础并开展更大规模的RCT，以更好地了解使用TXA的益处，目标是在心脏大手术和小手术后均保持低出血风险。
