Impact of tranexamic acid use on thrombosis in non-surgical patients

  • Chornenki NLJ & al.
  • Thromb Res
  • 1 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • 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.

Study design

  • 22 studies involving 49,538 patients met eligibility criteria after a search on MEDLINE, EMBASE and CENTRAL databases.
  • Funding: CanVECTOR research.

Key results

  • 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%).

Limitations

  • Heterogeneity among studies.