Background
Methods
Search strategy
Eligibility criteria
Selection of included studies
Assessment of risk of bias in included studies
Quality of the evidence
Study outcomes
Statistical methods
Results
Results of search
Description of included studies
Study ID | Country | No. C/T | Sex F/M | Type of GABG | AC discounted before surgery | Drug Dose and Treatment Regimens |
---|---|---|---|---|---|---|
Speekenbrink 1995 [23] | Netherlands | 15/15 | 2/28 | On-pump | 2 to 4 days | TA 10 mg·kg− 1 in 20 min after induction of anesthesia and continued at a rate of 1 mg·kg− 1 up to a total dose of 1000 mg. |
Brown 1997 [24] | United States | 30/30 | 11/49 | On-pump | NR | TA 15 mg·kg− 1 in 20 min after the induction and continued at a rate of 1 mg·kg− 1·hr.− 1 for 5 h |
Landymore 1997 [25] | Canada | 50/56 | NR | On-pump | < 2 days | TA 10 mg·kg-1 before CBP and continued at a rate of mg·kg− 1·hr.− 1 until the termination of CBP |
Hardy 1998 [26] | Canada | 45/43 | 23/65 | On-pump | NR | TA 10 g as a bolus over 20 min |
Casati 2001 [27] | Italy | 20/20 | 8/32 | Off-pump | < 1 day | TA 1 g as a bonus before skin incision, followed by continuous infusion of 400 mg·hr.− 1 during surgery |
Zabeeda 2002 [28] | Israel | 25/25 | 12/38 | On-pump | NR | TA 10 mg·kg− 1 in more than 15 min after induction of anesthesia and followed by a continuous infusion of 1 mg·kg− 1 per hour |
Jares 2003 [29] | Czech Republic | 22/25 | 12/35 | Off-pump | 5 days | TA 1 g as a bolus before skin incision, followed by continuous infusion of 200 mg·hr.− 1 during surgery |
Pleym 2003 [30] | Norway | 39/40 | 13/66 | On-pump | 1 day | TA 30 mg·kg− 1 as a bolus injection over 5 min immediately before the start of CPB. |
Andreasen 2004 [31] | Denmark | 23/21 | 7/37 | On-pump | > 7 days | TA 1.5 g as a bolus, followed by a constant infusion of 200 mg·hr.− 1 until 1.5 g |
Casati 2004 [4] | Italy | 50/52 | 16/86 | On-pump Off-pump | < 1 day | TA 1 g as a bonus before skin incision, followed by continuous infusion of 400 mg·hr.− 1 until completion of surgery with 500 mg added to priming in patients undergoing on-pump coronary artery bypass grafting |
Karski 2005 [32] | Canada | 165/147 | 37/275 | On-pump | 7 days | TA 100 mg·kg− 1 administered intravenously over 20 min after the induction of anesthesia |
Vanek 2005 [33] | Czech Republic | 30/32 | 14/38 | Off-pump | < 1 day | TA 1 g before skin incision and a continuous infusion of 200 mg·hr.− 1 during the whole surgical procedure. |
Santos 2006 [34] | Brasil | 31/29 | 17/43 | On-pump | NR | TA 10 mg·kg− 1 before the skin incision, followed by a continuous infusion of 1 mg·kg− 1·hr.− 1 for 5 h. |
Wei 2006 [35] | China | 40/36 | 16/60 | Off-pump | 5/−7 days | TA 0.75 g in 20 min at the beginning of surgery followed by continuous infusion of 0.25 g per hour throughout surgery. |
Maddali 2007 [36] | Oman | 111/111 | 70/152 | On-pump | 7 days | TA 10 mg·kg− 1 as a bolus prior to sternotomy, followed by an infusion (1 mg·kg− 1·hr.− 1) up to the time of starting of protamine. |
Mehr-Aein 2007 [3] | Iran | 33/33 | 2/27 | Off-pump | 7 days | TA 15 mg·kg− 1 before infusion of heparin and 15 mg·kg− 1 after protamine infusion |
Taghaddomi 2009 [37] | Iran | 50/50 | 28/72 | Off-pump | NR | TA 1 g was given 20 min before skin incision and 400 mg·hr.− 1 during the entire surgical procedure. |
Hashemi 2011 [38] | Iran | 50/50 | 24/76 | On-pump | NR | TA 1 g added to the pump prime solution and another 1 g was used intravenously after discontinuation of the pump |
Ahn 2012 [10] | Korea | 38/38 | 35/41 | Off-pump | 5 days | TA 1 g in 20 min before skin incision with subsequent continuous infusion at 200 mg·hr.− 1 during the operation |
Chakravarthy 2012 [11] | India | 50/50 | 22/78 | Off-pump | 7 days | TA 20 mg·kg− 1 over 30 min followed by infusion of 1 mg·kg− 1·hr.− 1 for 12 h |
Greiff 2012 [12] | Norway | 33/30 | 26/37 | On-pump | 1 day | TA 10 mg·kg-1 as a bolus injection before skin incision followed by an infusion of 1 mg·kg− 1·hr.− 1 until the end of surgery. |
Nejad 2012 [14] | Iran | 50/50 | 24/76 | On-pump | NR | TA 1 g was added to the pump prime solution and another 1 g was used intravenously after the discontinuation of the pump |
Wang 2012 [15] | China | 115/116 | 36/195 | Off-pump | 5 days | TA 1 g as a bolus injection 20 min before the incision followed by an infusion of 400 mg·hr.− 1 until the completion of the surgery |
Esfandiari 2013 [16] | Iran | 75/75 | 30/120 | On-pump | NR | TA 10 mg·kg− 1 added to the priming solution and a bolus dose of 1 mg·kg− 1 after weaning from CPB |
Shi 2013 [17] | China | 59/58 | 23/94 | On-pump | < 7 days | TA 15 mg·kg− 1 before surgical incision and 15 mg·kg− 1 after protamine neutralization |
Ghavidel 014 [39] | Iran | 100/100 | 65/135 | On-pump | 3 days | TA 10 mg·kg− 1 via prime solution and the maintenance dose of 0.5–2 mg·kg− 1·h− 1 in proportion to serum creatinine. |
Yanartas 2015 [18] | Turkey | 63/69 | 50/82 | On-pump | 5 days | TA 10 mg·kg− 1 before the skin incision, followed by a continuous infusion of 1 mg·kg− 1·h− 1 for 5 h. |
Myles 2017 [8] | Australia | 2322/2311 | 773/3860 | On-pump/ Off-pump | ≥4 days | TA 100 mg·kg− 1 or 50 mg·kg− 1 was administered intravenously more than 30 min after the induction of anesthesia |
Risk of bias within studies
Publication bias
Quantitative data synthesis
Cerebrovascular accident
Outcome | Sensitivity analyses | Studies (n) | TXA | Placebo | RR or MD | 95% CI | P value for effect | P value for heterogeneity |
---|---|---|---|---|---|---|---|---|
Cerebrovascular accident | Studies randomized not less 100 patients | 9 | 286/2999 | 318/3011 | 0.90 | 0.78–1.05 | 0.18 | 0.64 |
Study with maximum sample size excluded | 21 | 9/1062 | 10/1084 | 0.95 | 0.43–2.10 | 0.90 | 0.86 | |
Reoperation for bleeding | Studies randomized not less 100 patients | 8 | 29/2812 | 59/2821 | 0.49 | 0.32–0.77 | < 0.01 | 0.58 |
Study with maximum sample size excluded | 15 | 17/815 | 30/814 | 0.59 | 0.34–1.04 | 0.07 | 0.72 | |
Mortality | Studies randomized not less 100 patients | 7 | 31/2870 | 36/2886 | 0.87 | 0.54–1.40 | 0.56 | 0.46 |
Study with maximum sample size excluded | 16 | 7/875 | 8/898 | 0.93 | 0.38–2.27 | 0.88 | 0.75 | |
Myocardial infarction | Studies randomized not less 100 patients | 11 | 286/2999 | 318/3011 | 0.90 | 0.78–1.05 | 0.18 | 0.64 |
Study with maximum sample size excluded | 22 | 23/1039 | 25/1045 | 0.94 | 0.55–1.61 | 0.81 | 0.8 | |
Acute renal insufficiency | Studies randomized not less 100 patients | 7 | 105/2758 | 102/2769 | 1.03 | 0.79–1.35 | 0.81 | 0.89 |
Study with maximum sample size excluded | 13 | 12/658 | 14/667 | 0.88 | 0.42–1.84 | 0.73 | 0.94 | |
Transfusion of any blood products | Studies randomized not less 100 patients | 7 | 954/2494 | 1400/2504 | 0.64 | 0.50–0.81 | < 0.01 | < 0.01 |
Study with maximum sample size excluded | 10 | 139/396 | 216/363 | 0.29 | 0.20–0.40 | < 0.01 | < 0.01 | |
Postoperative chest tube drainage in the first 24 h | Studies randomized not less 100 patients | 7 | 2824 | 2850 | -208.3 | −274.12,-142.48 | < 0.01 | < 0.01 |
Study with maximum sample size excluded | 17 | 802 | 814 | −215.42 | −259.48, −171.57 | < 0.01 | < 0.01 |
Seizures
Reoperation for bleeding
Mortality
Myocardial infarction
Acute renal insufficiency
Transfusion of any blood products
Postoperative chest tube drainage in the first 24 h
Quality of the evidence
Outcomes | Illustrative comparative risksa (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
---|---|---|---|---|---|---|
Assumed risk Control | Corresponding risk Tranexamic acid versus placebo | |||||
Cerebrovascular accident | Study population | RR 0.93 (0.62 to 1.39) | 6775 (22 studies) | ⊕ ⊕ ⊕⊝ moderateb | ||
13 per 1000 | 12 per 1000 (8 to 18) | |||||
Moderate | ||||||
0 per 1000 | 0 per 1000 (0 to 0) | |||||
Seizure | Study population | RR 6.67 (1.77 to 25.20) | 4911 (4 studies) | ⊕ ⊕ ⊕ ⊕ highc,d | ||
1 per 1000 | 5 per 1000 (1 to 20) | |||||
Moderate | ||||||
0 per 1000 | 0 per 1000 (0 to 0) | |||||
Reoperation for bleeding | Study population | RR 0.46 (0.31 to 0.68) | 6259 (16 studies) | ⊕ ⊕ ⊕ ⊕ highe,f | ||
25 per 1000 | 11 per 1000 (8 to 17) | |||||
Moderate | ||||||
22 per 1000 | 10 per 1000 (7 to 15) | |||||
Mortality | Study population | RR 0.82 (0.53 to 1.28) | 6414 (17 studies) | ⊕ ⊕ ⊕⊝ moderateb,g | ||
13 per 1000 | 10 per 1000 (7 to 16) | |||||
Moderate | ||||||
0 per 1000 | 0 per 1000 (0 to 0) | |||||
Myocardial infarction | Study population | RR 0.9 (0.78 to 1.05) | 6714 (23 studies) | ⊕ ⊕ ⊕⊝ moderatee | ||
97 per 1000 | 87 per 1000 (75 to 101) | |||||
Moderate | ||||||
0 per 1000 | 0 per 1000 (0 to 0) | |||||
Acute renal insufficiency | Study population | RR 1.01 (0.78 to 1.3) | 5954 (14 studies) | ⊕ ⊕ ⊕⊝ moderateb | ||
37 per 1000 | 37 per 1000 (29 to 48) | |||||
Moderate | ||||||
20 per 1000 | 20 per 1000 (16 to 26) | |||||
Transfusion of any blood products | Study population | RR 0.64 (0.52 to 0.78) | 5360 (11 studies) | ⊕⊝⊝⊝ very lowb,h | ||
553 per 1000 | 354 per 1000 (288 to 432) | |||||
Moderate | ||||||
560 per 1000 | 358 per 1000 (291 to 437) | |||||
Postoperative chest tube drainage in the first 24 h | The mean postoperative chest tube drainage in the first 24 h in the intervention groups was 206.19 lower (248.23 to 164.15 lower) | 6247 (16 studies) | ⊕⊝⊝⊝ very lowh,i |