Topical tranexamic acid versus placebo in surgery

What is it about?

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.

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Why is it important?

In light of the safety concern regarding the theoretical risk of fatal thromboembolic event with intravenous administration of TXA, topical route of TXA has been proposed as an alternative measure to minimise blood loss. The plasma concentration of topical TXA was found to be 90% lower than intravenous TXA. However, topical TXA has been shown to result in a higher therapeutic concentration at the bleeding site with minimal or no systemic absorption. Many recent trials investigating the benefits of topical TXA in surgery have been published with conflicting results. Consequently, the efficacy and safety profile of topical TXA remains unclear in the literature. A systematic review and meta-analysis are timely warranted to synthesize current evidence on the prophylactic use of TXA in adults undergoing surgery. The primary aim of this systematic review and meta-analysis was to evaluate the effects of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery. Secondary aims were to investigate the clinical effects of TXA on 1) bleeding outcomes reflected by total blood loss, total drain output, intra-operative blood loss and change in haemoglobin, 2) length of hospital stay, 3) surgical site infection and 4) adverse events associated with TXA use namely, myocardial infarction, stroke, pulmonary embolism and deep vein thrombosis.

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