Nicholas L Jackson Chornenki1, Kevin J Um2, Pablo A Mendoza3, Ashkan Samienezhad3, Vidushi Swarup3, Chatree Chai-Adisaksopha2, Deborah M Siegal4. 1. Department of Medicine, McMaster University, Hamilton, Canada. Electronic address: nicholas.jacksonchornenki@medportal.ca. 2. Department of Medicine, McMaster University, Hamilton, Canada. 3. Population Health Research Institute, McMaster University, Hamilton, Canada. 4. Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, McMaster University, Hamilton, Canada.
Abstract
BACKGROUND: Antifibrinolytic agents such as tranexamic acid (TXA) are commonly used as adjunctive therapies to prevent and treat excessive bleeding. In non-surgical settings, TXA is known to reduce bleeding related mortality. However, impact of TXA use on thrombosis is uncertain. METHODS: We systematically searched the MEDLINE, EMBASE, and CENTRAL databases from January 1985 to August 2018. Studies with the following characteristics were included: (i) RCT design; (ii) compared systemic (oral or intravenous) TXA for prevention or treatment of bleeding for non-surgical indications and placebo or no TXA, and (iii) reported thrombotic events or mortality. A Mantel-Haenzel, random-effects model was used to calculate risk ratios, and risk of bias was assessed using the Cochrane risk of bias tool. RESULTS: Our search identified 22 studies representing 49,538 patients. Those receiving TXA had a significantly lower risk of death from any cause (RR = 0.92; 95% CI = 0.87-0.98; I2 = 0%). There was no significant increase in the risk of 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%), or deep vein thrombosis (RR = 0.99; 95% CI = 0.70-1.41; I2 = 0%) from use of TXA. The results were similar when restricted to studies at low risk of bias. CONCLUSIONS: In our systematic review and meta-analysis, the use of tranexamic acid reduced all-cause mortality without increased risk of venous or arterial thrombotic complications.
BACKGROUND: Antifibrinolytic agents such as tranexamic acid (TXA) are commonly used as adjunctive therapies to prevent and treat excessive bleeding. In non-surgical settings, TXA is known to reduce bleeding related mortality. However, impact of TXA use on thrombosis is uncertain. METHODS: We systematically searched the MEDLINE, EMBASE, and CENTRAL databases from January 1985 to August 2018. Studies with the following characteristics were included: (i) RCT design; (ii) compared systemic (oral or intravenous) TXA for prevention or treatment of bleeding for non-surgical indications and placebo or no TXA, and (iii) reported thrombotic events or mortality. A Mantel-Haenzel, random-effects model was used to calculate risk ratios, and risk of bias was assessed using the Cochrane risk of bias tool. RESULTS: Our search identified 22 studies representing 49,538 patients. Those receiving TXA had a significantly lower risk of death from any cause (RR = 0.92; 95% CI = 0.87-0.98; I2 = 0%). There was no significant increase in the risk of 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%), or deep vein thrombosis (RR = 0.99; 95% CI = 0.70-1.41; I2 = 0%) from use of TXA. The results were similar when restricted to studies at low risk of bias. CONCLUSIONS: In our systematic review and meta-analysis, the use of tranexamic acid reduced all-cause mortality without increased risk of venous or arterial thrombotic complications.
Authors: Eva N Hamulyák; Hanke M G Wiegers; Luuk J J Scheres; Barbara A Hutten; Maria E de Lange; Anne Timmermans; Peter E Westerweel; Marten R Nijziel; Marieke J H A Kruip; Marije Ten Wolde; Paula F Ypma; Frederikus A Klok; Laurens Nieuwenhuizen; Sanne van Wissen; Marcel M C Hovens; Laura M Faber; Pieter W Kamphuisen; Harry R Büller; Saskia Middeldorp Journal: Res Pract Thromb Haemost Date: 2020-12-18
Authors: Adam Miszta; Homa K Ahmadzia; Naomi L C Luban; Shuhui Li; Dong Guo; Lori A Holle; Jeffrey S Berger; Andra H James; Jogarao V S Gobburu; John van den Anker; Bas de Laat; Alisa S Wolberg Journal: J Thromb Haemost Date: 2020-12-26 Impact factor: 5.824
Authors: S Immenga; R Lodewijkx; Y B W E M Roos; S Middeldorp; C B L M Majoie; H C Willems; W P Vandertop; D Verbaan Journal: Trials Date: 2022-01-18 Impact factor: 2.279