BACKGROUND AND PURPOSE:

• Tranexamic acid (TXA) is used to reduce blood loss and transfusion perioperatively
  • Topical administration of TXA has been studied, but its safety and efficacy are still unclear
• Teoh et al. (Annals of Surgery, 2020) performed a review to assess the effect of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery

METHODS:

• Systematic review and meta-analysis
• Data sources
• EMBASE, MEDLINE, CENTRAL, and ISI Web of Science Inclusion criteria
• Study inclusion requirements
  • Parallel-arm RCTs

RESULTS:

• Total 71 trials | Combined total of 7539 participants
  • Orthopedic participants: 5450
  • Nonorthopedic including gyn: 1909
• Risk of bias assessment for all included studies
  • Low: 20 studies
  • Unclear: 26 studies
  • High: 25 studies
• Variation in dosing and route
  • Dosage of topical TXA: 0.5 g to 3.0 g of TXA in 20 to 400mL of normal saline
  • Application route: Wound irrigation and spraying | Gyn studies included applying a soaked sponge onto the operative site or wound irrigation
• When compared to placebo, topical TXA significantly reduced
  • Intraoperative blood loss: Mean difference (MD) -36.83 mL (95% 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)
  • Incidence of blood transfusion: Odds ratio (OR) 0.30 (95% CI 0.26 to 0.34; P<0.001)
• 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)
• The following adverse events were not associated with topical TXA
  • Mortality: P=0.39
  • Pulmonary embolism: P=0.52
  • DVT: P=0.79
  • Myocardial infarction: P=0.73
  • Stroke: P = 0.77

CONCLUSION:

• Topical TXA was associated with a decrease in intraoperative blood loss, total blood loss | Blood transfusion was reduced by 70%
• TXA dose and route varied | However, previous studies did not find TXA effect to be dose dependent
• Mortality was not affected
  • However, authors note that larger numbers may be required To detect differences in mortality
  • Mortality is at higher risk for confounding due to various comorbidities and other factors
• No adverse effects related to the use of topical TXA were observed

Learn More – Primary Sources:

Prophylactic Topical Tranexamic Acid Versus Placebo in Surgical Patients: A Systematic Review and Meta-Analysis

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