- This meta-analysis suggests tranexamic acid (TXA) when given for prevention or treatment of non-surgical bleeding significantly reduces all-cause mortality without an increased risk for venous or arterial thrombotic complications.
- However, results should be interpreted with caution for patients with a history of thrombosis as they were not included in the TXA trials.
Why this matters
- Previous studies have demonstrated that the initial administration of TXA reduces bleeding-related mortality in trauma patients. However, the effect of TXA on thrombosis is unclear.
- 22 studies involving 49,538 patients met eligibility criteria after a search on MEDLINE, EMBASE and CENTRAL databases.
- Funding: CanVECTOR research.
- Patients who received TXA vs those without had a significantly lower risk of death from any cause (relative risk [RR], 0.92; 95% CI, 0.87-0.98; I2=0%).
- Intravenous (IV) TXA administration vs oral and combined (oral/IV) significantly reduced mortality:
- IV (RR, 0.92; 95% CI, 0.87-0.97; I2=0%).
- oral (RR, 0.98; 95% CI, 0.32-3.02; I2=0%).
- combined (RR, 0.60; 95% CI, 0.25-1.47; I2=0%).
- TXA administration was not associated with a significant increase in:
- stroke (RR, 1.10; 95% CI, 0.68-1.78; I2=31%),
- myocardial infarction (RR, 0.88; 95% CI, 0.43-1.84; I2=46%),
- pulmonary embolism (RR, 0.97; 95% CI, 0.75-1.26; I2= 0%), and
- deep vein thrombosis (RR, 0.97; 95% CI, 0.69-1.37; I2=0%).
- Heterogeneity among studies.