This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Systematic review, meta‐analysis and meta‐regression of the effect of tranexamic acid on surgical blood loss. BJS 2013; 100: 1271-1279.

Published: 9th July 2013

Authors: K. Ker, D. Prieto‐Merino, I. Roberts

Background

Tranexamic acid (TXA) reduces blood transfusion in surgery but the extent of the reduction in blood loss and how it relates to the dose of TXA is unclear.

Method

A systematic review of randomized trials was performed. Data were extracted on blood loss from trials comparing intravenous TXA with no TXA or placebo in surgical patients. A Bayesian linear regression was used to describe the relationship between the reduction in blood loss with TXA and the extent of bleeding as measured by the mean blood loss in the control group. A meta‐analysis of the log‐transformed data was conducted to quantify the effect of TXA on blood loss, stratified by type of surgery, timing of TXA administration and trial quality. Meta‐regression was used to explore the effect of TXA dosage.

Results

Data from 104 trials were examined. Although the absolute reduction in blood loss with TXA increased as surgical bleeding increased, the percentage reduction was similar. TXA reduced blood loss by 34 per cent (pooled ratio 0·66, 95 per cent confidence interval 0·65 to 0·67; P < 0·001). The percentage reduction in blood loss with TXA differed by type of surgery, timing of TXA administration and trial quality, but the differences were small. The effect of TXA on blood loss did not vary over the range of doses assessed (5·5–300 mg/kg).

Conclusion

TXA reduces blood loss in surgical patients by about one‐third. A total dose of 1 g appears to be sufficient for most adults. There is no evidence to support the use of high doses.

Full text

You may also be interested in

Leading article

Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

Authors: J. H. H. Olsen, S. Öberg, K. Andresen, T. W. Klausen, J. Rosenberg

Original article

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons’ national registry. BJS 2019; 106: 1495-1503.

Authors: N. Patel, R. J. Egan, B. R. Carter, D. M. Scott‐Coombes, M. J. Stechman, A. Afzaal et al.

Systematic review, meta‐analysis and meta‐regression of the effect of tranexamic acid on surgical blood loss. BJS 2013; 100: 1271-1279.

Background

Method

Results

Conclusion

You may also be interested in

A good surgical death. BJS 2019; 106: 1427-1428.

Randomized controlled trial of plain English and visual abstracts for disseminating surgical research via social media.

Effect of donor nephrectomy time during circulatory‐dead donor kidney retrieval on transplant graft failure.

Systematic review of the current status of cadaveric simulation for surgical training.

Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours.

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury.

Trauma models to identify major trauma and mortality in the prehospital setting.

5G‐assisted telementored surgery.

Validation of the Norwegian survival prediction model in trauma (NORMIT) in Swedish trauma populations.

Human model of burn injury that quantifies the benefit of cooling as a first aid measure. BJS 2019; 106: 1472-1479.

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons’ national registry. BJS 2019; 106: 1495-1503.