The Efficacy And Safety Of Tranexamic Acid In Patients Undergoing Off-pump Coronary Bypass Grafting: A Systematic Review And Meta-analysis

Background and Purpose:Tranexamic acid reduces blood loss and transfusion in on-pump coronary artery bypass graft(CABG) surgery.Compared with on-pump, off-pump surgery is ssociated with less blood loss and transfusion. Therefore, tranexamic acid may be less effective for off-pump surgery,and its safety profile may be different in this setting. The aim of this study is to evaluate the efficacy and safety of tranexamic acid for patients undergoing off-pump coronary bypass grafting.MethodsThe MEDLINE、EMBASE、Cochrane Library、CNKI,Wan Fang,VIP and Google Scholar were searched for randomized controlled trials(RCTs) of patients undergoing off-pump coronary bypass grafting in March 2014 by using the English or Chinese search terms:off-pump coronary revascularization,off-pump coronary bypass,off pump coronary surgery,transamin,cyklokapron,off-pump coronary artery bypass surgery,OPCAB,Off-Pump Coronary Artery By Pass,TA. An another search using reference lists of articles and recent reviews was also carried out by us.We evaluated the quality of all the studies,and extracted the data which met the inclusion criteria.Review Manager Software 5.2 Was used for statistical analysis.ResultsTen randomized controlled trials were identified via electronic literature search strategy. The 10 included trials with a total of 851 patients in the present analysis randomized to either a tranexamic acid treatment group or a control group. Analysis using the Cochrane Collaboration Tool for Assessment of Bias indicated a low risk of bias within the majority of the studies. The only study with a high risk of bias was by Jares et al, relating to aspects of their methodology.Tranexamic acid significantly reduced the postoperative blood loss(24h)(SD=-208.41,95%CI [-311.48,-105.35], P < 0.0001),overall risk of allogeneic blood component transfusion(RR=0.47,95%CI[0.33, 0.66], P < 0.0001),and packed red blood cell transfusions(RR=0. 60,95%CI[0. 49, 0. 74], P <0.00001).But no association was found between tranexamic acid and adverse thrombotic events.ConclusionTranexamic acid significantly reduced the postoperative blood loss and overall risk of allogeneic in petients undergoing OPCAB. However, because of the limited quality of the included studies, further evidence with more high quality studies is still needed.