Topical Versus Intravenous Tranexamic Acid in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

To compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in patients undergoing cardiac surgery.

A systematic review and meta-analysis were conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, and Scopus databases were searched for randomized controlled trials (RCTs) comparing topical and intravenous TXA in cardiac surgery.

Only RCTs involving pediatric and/or adult patients undergoing cardiac surgery were included. Six RCTs encompassing 3,577 patients (1,792 topical TXA; 1,785 intravenous TXA) met the inclusion criteria.

Topical versus intravenous TXA administration in cardiac surgery.

Outcomes included postoperative blood loss, hemoglobin levels, transfusion requirements, and clinical and safety outcomes. The overall analysis revealed no significant difference in total postoperative blood loss between the two groups (mean difference = -16.66, 95% confidence interval = -41.01 to 7.69, p = 0.18). Subgroup analysis showed that topical TXA significantly reduced blood loss at 48 hours in pediatric patients (mean difference = -8.63, 95% confidence interval = -16.77 to -0.49, p = 0.04), but no significant difference was observed at 24 hours in adults. No significant differences were found in hemoglobin level changes, transfusion requirements, or clinical outcomes. Safety analyses showed comparable rates of mortality, reoperation, seizures, infections, respiratory failure, intensive care unit length of stay, and ventilation duration.

The findings suggest that topical and intravenous TXA demonstrate similar efficacy in reducing perioperative bleeding in cardiac surgery, with no significant differences in safety outcomes. However, topical TXA may have a delayed benefit in pediatric patients. Larger, high-quality RCTs are warranted to confirm these findings and to optimize TXA administration strategies in different patient populations.