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Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*

Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and effica...

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التفاصيل البيبلوغرافية
المؤلفون الرئيسيون: Teoh, Wan Yi, Tan, Tun Giap, Ng, Ka Ting, Ong, Ke Xin, Chan, Xue Lin, Hung Tsan, Samuel Ern, Wang, Chew Yin
التنسيق: مقال
منشور في: Lippincott, Williams & Wilkins 2021
الموضوعات:
R Medicine
RD Surgery
الوصول للمادة أونلاين:http://eprints.um.edu.my/28819/
الوسوم: إضافة وسم
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id my.um.eprints.28819
record_format eprints
spelling my.um.eprints.288192022-08-18T04:31:09Z http://eprints.um.edu.my/28819/ Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis* Teoh, Wan Yi Tan, Tun Giap Ng, Ka Ting Ong, Ke Xin Chan, Xue Lin Hung Tsan, Samuel Ern Wang, Chew Yin R Medicine RD Surgery Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and efficacy profile remain unclear in the literature. The primary aim of this review was to assess the effect of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery. Data sources: EMBASE, MEDLINE, CENTRAL, and ISI Web of Science were systematically searched from their inception until May 31, 2019. Review methods: Parallel-arm randomized controlled trials were included. Results: Seventy-one trials (7539 participants: orthopedics 5450 vs nonorthopedics 1909) were included for quantitative meta-analysis. In comparison to placebo, topical TXA significantly reduced intraoperative blood loss mean difference (MD) -36.83 mL, 95% confidence interval (CI) -54.77 to -18.88, P < 0.001], total blood loss (MD -319.55 mL, 95% CI -387.42 to -251.69, P < 0.001), and incidence of blood transfusion odds ratio (OR) 0.30, 95% CI 0.26-0.34, P < 0.001]. Patients who received topical TXA were associated with a shorter length of hospital stay (MD -0.28 days, 95% CI -0.47 to -0.08, P = 0.006). No adverse events associated with the use of topical TXA were observed, namely mortality (OR 0.78, 95% CI 0.45-1.36, P = 0.39), pulmonary embolism (OR 0.73, 95% CI 0.27-1.93, P = 0.52), deep vein thrombosis (OR 1.07, 95% CI 0.65-1.77, P = 0.79), myocardial infarction (OR 0.79, 95% CI 0.21-2.99, P = 0.73), and stroke (OR 0.85, 95% CI 0.28-2.57, P = 0.77). Of all included studies, the risk of bias assessment was ``low'' for 20 studies, ``unclear'' for 26 studies and ``high'' for 25 studies. Conclusions: In the meta-analysis of 71 trials (7539 patients), topical TXA reduced the incidence of blood transfusion without any notable adverse events associated with TXA in adults undergoing surgery. PROSPERO: CRD 42018111762. Lippincott, Williams & Wilkins 2021-04 Article PeerReviewed Teoh, Wan Yi and Tan, Tun Giap and Ng, Ka Ting and Ong, Ke Xin and Chan, Xue Lin and Hung Tsan, Samuel Ern and Wang, Chew Yin (2021) Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*. Annals of Surgery, 273 (4). pp. 676-683. ISSN 0003-4932, DOI https://doi.org/10.1097/SLA.0000000000003896 <https://doi.org/10.1097/SLA.0000000000003896>. 10.1097/SLA.0000000000003896
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
RD Surgery
spellingShingle R Medicine
RD Surgery
Teoh, Wan Yi
Tan, Tun Giap
Ng, Ka Ting
Ong, Ke Xin
Chan, Xue Lin
Hung Tsan, Samuel Ern
Wang, Chew Yin
Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
description Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and efficacy profile remain unclear in the literature. The primary aim of this review was to assess the effect of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery. Data sources: EMBASE, MEDLINE, CENTRAL, and ISI Web of Science were systematically searched from their inception until May 31, 2019. Review methods: Parallel-arm randomized controlled trials were included. Results: Seventy-one trials (7539 participants: orthopedics 5450 vs nonorthopedics 1909) were included for quantitative meta-analysis. In comparison to placebo, topical TXA significantly reduced intraoperative blood loss mean difference (MD) -36.83 mL, 95% confidence interval (CI) -54.77 to -18.88, P < 0.001], total blood loss (MD -319.55 mL, 95% CI -387.42 to -251.69, P < 0.001), and incidence of blood transfusion odds ratio (OR) 0.30, 95% CI 0.26-0.34, P < 0.001]. Patients who received topical TXA were associated with a shorter length of hospital stay (MD -0.28 days, 95% CI -0.47 to -0.08, P = 0.006). No adverse events associated with the use of topical TXA were observed, namely mortality (OR 0.78, 95% CI 0.45-1.36, P = 0.39), pulmonary embolism (OR 0.73, 95% CI 0.27-1.93, P = 0.52), deep vein thrombosis (OR 1.07, 95% CI 0.65-1.77, P = 0.79), myocardial infarction (OR 0.79, 95% CI 0.21-2.99, P = 0.73), and stroke (OR 0.85, 95% CI 0.28-2.57, P = 0.77). Of all included studies, the risk of bias assessment was ``low'' for 20 studies, ``unclear'' for 26 studies and ``high'' for 25 studies. Conclusions: In the meta-analysis of 71 trials (7539 patients), topical TXA reduced the incidence of blood transfusion without any notable adverse events associated with TXA in adults undergoing surgery. PROSPERO: CRD 42018111762.
format Article
author Teoh, Wan Yi
Tan, Tun Giap
Ng, Ka Ting
Ong, Ke Xin
Chan, Xue Lin
Hung Tsan, Samuel Ern
Wang, Chew Yin
author_facet Teoh, Wan Yi
Tan, Tun Giap
Ng, Ka Ting
Ong, Ke Xin
Chan, Xue Lin
Hung Tsan, Samuel Ern
Wang, Chew Yin
author_sort Teoh, Wan Yi
title Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
title_short Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
title_full Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
title_fullStr Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
title_full_unstemmed Prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
title_sort prophylactic topical tranexamic acid versus placebo in surgical patients a systematic review and meta-analysis*
publisher Lippincott, Williams & Wilkins
publishDate 2021
url http://eprints.um.edu.my/28819/
_version_ 1744649141593571328
score 13.251813

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