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Perioperative tranexamic acid in burn surgery: systematic review and meta-analysis of randomized controlled trials
Maria Eduarda Molinari1, Ramon Huntermann1, Julia C Bernardi1
1Centro Universitário para o Desenvolvimento de Alto Vale, Rio do Sul, SC, Brazil.
Introduction:
Burn injuries often require surgery, posing challenges due to significant intraoperative blood loss and transfusion risks. Tranexamic Acid (TXA), an antifibrinolytic agent, stabilizes clots and reduces fibrinolysis, with proven efficacy in various surgical settings. However, the benefits in burn patients are yet to be established.
Methods:
We performed a systematic review and meta-analysis. PubMed, Embase, and Cochrane databases were searched for Randomized Clinical Trials (RCTs) comparing TXA versus control in burned patients. Risk Ratios (RR) and Mean Differences (MD) with 95% CIs were computed for binary and continuous outcomes, respectively. The primary endpoint of interest was blood loss. Statistical analyses were performed using RStudio software (version 4.2.2). The certainty of the evidence was evaluated using the GRADE approach.
Results:
Four RCTs comprising 204 patients were included, with 102 (50%) assigned to the TXA group. The mean patient age across studies ranged from 32.15 to 39.70 years. TXA significantly reduced total blood loss (MD = -183.93 mL; 95% CI: -278.44 to -89.42; p < 0.01), need for packed red blood cell transfusions (RR = 0.42, 95% CI 0.26 to 0.66; p < 0.01), while also improving hematocrit (MD = 3.49%; 95% CI: 1.58 to 5.41; p < 0.01) and hemoglobin levels (MD = 0.87 g.dL-1; 95% CI: 0.35 to 1.39; p < 0.01).
Conclusion:
In patients with burns, TXA was associated with reduced blood loss and packed cell transfusions. However, certainty is limited by the small number and heterogeneity of available trials.
Registration:
PROSPERO ID: CRD420251000356. Registered on 07 March 2025.
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