Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background and Objectives:. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess efficacy and safety of tranexamic acid (TXA) use in acute traumatic injuries. Methods:. PubMed and Cochrane libraries were searched for relevant RCTs published between January 2...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2021-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000105 |
| _version_ | 1797732767520260096 |
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| author | Scott Rowe, BS Amy Liu, BS Israel Zagales, MD Muhammad Awan, BS Radleigh Santos, PhD Mark McKenney, MD, MBA, FACS Adel Elkbuli, MD, MPH |
| author_facet | Scott Rowe, BS Amy Liu, BS Israel Zagales, MD Muhammad Awan, BS Radleigh Santos, PhD Mark McKenney, MD, MBA, FACS Adel Elkbuli, MD, MPH |
| author_sort | Scott Rowe, BS |
| collection | DOAJ |
| description | Background and Objectives:. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess efficacy and safety of tranexamic acid (TXA) use in acute traumatic injuries.
Methods:. PubMed and Cochrane libraries were searched for relevant RCTs published between January 2011 and January 3, 2021. Cohen’s Q Test for heterogeneous effects was used to determine the appropriateness of fixed versus random effects models.
Results:. Twenty-two studies met inclusion criteria. Meta-analysis of relative risk of mortality between treatment and placebo groups in the in-hospital, and perioperative settings was not significant. However, the risk of mortality is significantly lower in the treatment versus placebo group when TXA was given as loading dose only. Ten of the 11 studies evaluating perioperative use of TXA included in systematic review found significantly lower blood loss in the treatment compared with placebo groups, but results of meta-analysis showed no significant difference. Results of meta-analysis indicate that the risk of venous thromboembolism (VTE) in the in-hospital treatment group is greater than that of the placebo. In subset analysis of studies using only a single loading dose, there were no significant differences in VTE.
Conclusions:. Systematic review supports TXA benefits are most evident when given shortly after injury and meta-analysis supports TXA reduces mortality as a single loading dose. Systematic review supports perioperative use of TXA when large volume blood loss is anticipated. Meta-results showed no significant difference in risk of thromboembolism in single-dose TXA treatment compared with placebo. These findings suggest that TXA is safe and effective for control of traumatic bleeding. |
| first_indexed | 2024-03-12T12:19:16Z |
| format | Article |
| id | doaj.art-01e1996735ac4135805dcd69c14cac39 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:19:16Z |
| publishDate | 2021-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-01e1996735ac4135805dcd69c14cac392023-08-30T06:09:12ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932021-12-0124e10510.1097/AS9.0000000000000105202112000-00009Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsScott Rowe, BS0Amy Liu, BS1Israel Zagales, MD2Muhammad Awan, BS3Radleigh Santos, PhD4Mark McKenney, MD, MBA, FACS5Adel Elkbuli, MD, MPH6From the * Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FLFrom the * Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FLFrom the * Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FLFrom the * Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL† Department of Mathematics, Nova Southeastern University, Davie, FLFrom the * Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FLFrom the * Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FLBackground and Objectives:. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess efficacy and safety of tranexamic acid (TXA) use in acute traumatic injuries. Methods:. PubMed and Cochrane libraries were searched for relevant RCTs published between January 2011 and January 3, 2021. Cohen’s Q Test for heterogeneous effects was used to determine the appropriateness of fixed versus random effects models. Results:. Twenty-two studies met inclusion criteria. Meta-analysis of relative risk of mortality between treatment and placebo groups in the in-hospital, and perioperative settings was not significant. However, the risk of mortality is significantly lower in the treatment versus placebo group when TXA was given as loading dose only. Ten of the 11 studies evaluating perioperative use of TXA included in systematic review found significantly lower blood loss in the treatment compared with placebo groups, but results of meta-analysis showed no significant difference. Results of meta-analysis indicate that the risk of venous thromboembolism (VTE) in the in-hospital treatment group is greater than that of the placebo. In subset analysis of studies using only a single loading dose, there were no significant differences in VTE. Conclusions:. Systematic review supports TXA benefits are most evident when given shortly after injury and meta-analysis supports TXA reduces mortality as a single loading dose. Systematic review supports perioperative use of TXA when large volume blood loss is anticipated. Meta-results showed no significant difference in risk of thromboembolism in single-dose TXA treatment compared with placebo. These findings suggest that TXA is safe and effective for control of traumatic bleeding.http://journals.lww.com/10.1097/AS9.0000000000000105 |
| spellingShingle | Scott Rowe, BS Amy Liu, BS Israel Zagales, MD Muhammad Awan, BS Radleigh Santos, PhD Mark McKenney, MD, MBA, FACS Adel Elkbuli, MD, MPH Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Annals of Surgery Open |
| title | Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full | Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_short | Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_sort | effectiveness and safety of tranexamic acid use in acute traumatic injury in the prehospital and in hospital settings a systematic review and meta analysis of randomized controlled trials |
| url | http://journals.lww.com/10.1097/AS9.0000000000000105 |
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