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Topical Versus Intravenous Tranexamic Acid in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
Karam R Motawea1, Yousef Tanas2, Merna Abouelenien3
1Cardiac Surgery Department, University Hospitals Cleveland Medical Center, Cleveland, OH.
Journal of Cardiothoracic and Vascular Anesthesia
|February 12, 2026
Summary
Topical and intravenous tranexamic acid (TXA) show similar effectiveness in reducing bleeding during cardiac surgery. While both are safe, topical TXA may offer a delayed benefit for pediatric patients.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Perioperative bleeding is a significant concern in cardiac surgery.
- Tranexamic acid (TXA) is used to reduce blood loss.
- The optimal administration route (topical vs. intravenous) is debated.
Purpose of the Study:
- To compare the efficacy and safety of topical versus intravenous tranexamic acid (TXA) in cardiac surgery patients.
- To analyze postoperative blood loss, transfusion needs, and clinical outcomes.
- To evaluate safety profiles, including mortality and adverse events.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched PubMed, Web of Science, and Scopus for relevant RCTs.
- Included 6 RCTs with 3,577 patients comparing topical and intravenous TXA.
Main Results:
- No significant difference in overall postoperative blood loss between topical and intravenous TXA.
- Topical TXA showed a significant reduction in blood loss at 48 hours in pediatric patients (p=0.04).
- Comparable rates of hemoglobin changes, transfusion requirements, clinical outcomes, and safety events were observed.
Conclusions:
- Topical and intravenous TXA are similarly effective and safe for reducing perioperative bleeding in cardiac surgery.
- Topical TXA may provide a delayed benefit in pediatric populations.
- Further high-quality RCTs are needed to refine TXA administration strategies.
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