Topical use of tranexamic acid in cardiac surgery-A review and meta-analysis of four randomized controlled trials

The article deals with the issue of topical use of tranexamic acid in cardiac surgery. Four randomized, double-blind trials comparing tranexamic acid vs. placebo were identified in the available literature (371 patients in total). In all of these studies the topical application of tranexamic acid significantly reduced postoperative blood loss, whereas a significant reduction of transfusion requirements was only described in one of these studies. A meta-analytic approach confirmed a significant reduction in blood loss (in 24 h) by 321.6 mL on average (95% confidence interval −530.3 mL, −112.9 mL; p=0.003). Another trial was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application. Despite an evident tendency toward lower blood loss in the group treated also topically, the differences between groups in this study did not reach statistical significance. There is an apparent need for further controlled trials with larger groups of patients.