Article description

Summary:

• This systematic review and meta-analysis evaluated the effect of topical lysine analog antifibrinolytics (LAAF), specifically tranexamic acid (TXA) and aminocaproic acid (EACA), on postoperative bleeding in cardiac surgery;
• A total of 26 studies, including 24 randomized controlled trials and 2 observational studies, comprising 2,624 patients, were included, the majority involving adult cardiac surgery populations;
• Primary outcome showed a significant reduction in postoperative blood loss with topical antifibrinolytics compared to control (MD ?173.99, 95% CI ?238.20 to ?109.78, p < 0.00001), and the effect remained consistent across subgroup analyses;
• Secondary outcomes showed no differences in packed red blood cell or platelet transfusion rates, while topical antifibrinolytics reduced packed red blood cell transfusion volume (MD ?0.6 units, 95% CI ?0.88 to ?0.24, p = 0.00006) and fresh frozen plasma transfusion rate (RR 0.69, 95% CI 0.5 to 0.95, p = 0.03).
• No significant differences were observed in hematological parameters or major postoperative outcomes, including re-exploration, seizure, stroke, myocardial infarction, all-cause mortality, new-onset arrhythmias, or length of stay.
• A trial sequential analysis suggests there is enough data to confirm this effect.

Conclusions:

• Topical antifibrinolytics reduce postoperative blood loss and transfusion requirements in cardiac surgery without increasing complications, supporting their role as an adjunct strategy in perioperative blood management.
• Future studies should focus on standardizing dosing protocols, conducting long-term postoperative follow-up, and exploring the use of antifibrinolytics across various surgical settings.