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Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis
BACKGROUND: Tranexamic acid (TXA) reduces surgical bleeding and reduces death from bleeding after trauma and childbirth. However, its effects on thrombotic events and seizures are less clear. We conducted a systematic review and meta-analysis to examine the safety of TXA in bleeding patients. METHOD...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8561958/ https://www.ncbi.nlm.nih.gov/pubmed/34724964 http://dx.doi.org/10.1186/s13054-021-03799-9 |
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author | Murao, Shuhei Nakata, Hidekazu Roberts, Ian Yamakawa, Kazuma |
author_facet | Murao, Shuhei Nakata, Hidekazu Roberts, Ian Yamakawa, Kazuma |
author_sort | Murao, Shuhei |
collection | PubMed |
description | BACKGROUND: Tranexamic acid (TXA) reduces surgical bleeding and reduces death from bleeding after trauma and childbirth. However, its effects on thrombotic events and seizures are less clear. We conducted a systematic review and meta-analysis to examine the safety of TXA in bleeding patients. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials from inception until June 1, 2020. We included randomized trials comparing intravenous tranexamic acid and placebo or no intervention in bleeding patients. The primary outcomes were thrombotic events, venous thromboembolism, acute coronary syndrome, stroke and seizures. A meta-analysis was performed using a random effects model and meta-regression analysis was performed to evaluate how effects vary by dose. We assessed the certainty of evidence using the grading of recommendations, assessment, development and evaluations (GRADE) approach. RESULTS: A total of 234 studies with 102,681 patients were included in the meta-analysis. In bleeding patients, there was no evidence that TXA increased the risk of thrombotic events (RR = 1.00 [95% CI 0.93–1.08]), seizures (1.18 [0.91–1.53]), venous thromboembolism (1.04 [0.92–1.17]), acute coronary syndrome (0.88 [0.78–1.00]) or stroke (1.12 [0.98–1.27]). In a dose-by-dose sensitivity analysis, seizures were increased in patients receiving more than 2 g/day of TXA (3.05 [1.01–9.20]). Meta-regression showed an increased risk of seizures with increased dose of TXA (p = 0.011). CONCLUSION: Tranexamic acid did not appear to increase the risk of thrombotic events in bleeding patients. However, because there may be dose-dependent increase in the risk of seizures, very high doses should be avoided. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03799-9. |
format | Online Article Text |
id | pubmed-8561958 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-85619582021-11-03 Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis Murao, Shuhei Nakata, Hidekazu Roberts, Ian Yamakawa, Kazuma Crit Care Research BACKGROUND: Tranexamic acid (TXA) reduces surgical bleeding and reduces death from bleeding after trauma and childbirth. However, its effects on thrombotic events and seizures are less clear. We conducted a systematic review and meta-analysis to examine the safety of TXA in bleeding patients. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials from inception until June 1, 2020. We included randomized trials comparing intravenous tranexamic acid and placebo or no intervention in bleeding patients. The primary outcomes were thrombotic events, venous thromboembolism, acute coronary syndrome, stroke and seizures. A meta-analysis was performed using a random effects model and meta-regression analysis was performed to evaluate how effects vary by dose. We assessed the certainty of evidence using the grading of recommendations, assessment, development and evaluations (GRADE) approach. RESULTS: A total of 234 studies with 102,681 patients were included in the meta-analysis. In bleeding patients, there was no evidence that TXA increased the risk of thrombotic events (RR = 1.00 [95% CI 0.93–1.08]), seizures (1.18 [0.91–1.53]), venous thromboembolism (1.04 [0.92–1.17]), acute coronary syndrome (0.88 [0.78–1.00]) or stroke (1.12 [0.98–1.27]). In a dose-by-dose sensitivity analysis, seizures were increased in patients receiving more than 2 g/day of TXA (3.05 [1.01–9.20]). Meta-regression showed an increased risk of seizures with increased dose of TXA (p = 0.011). CONCLUSION: Tranexamic acid did not appear to increase the risk of thrombotic events in bleeding patients. However, because there may be dose-dependent increase in the risk of seizures, very high doses should be avoided. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03799-9. BioMed Central 2021-11-01 /pmc/articles/PMC8561958/ /pubmed/34724964 http://dx.doi.org/10.1186/s13054-021-03799-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Murao, Shuhei Nakata, Hidekazu Roberts, Ian Yamakawa, Kazuma Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
title | Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
title_full | Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
title_fullStr | Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
title_full_unstemmed | Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
title_short | Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
title_sort | effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8561958/ https://www.ncbi.nlm.nih.gov/pubmed/34724964 http://dx.doi.org/10.1186/s13054-021-03799-9 |
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