Tranexamic acid in burn surgery: A systematic review and meta-analysis |
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| Affiliation: | 1. Anne Burnett Marion School of Medicine, Texas Christian University, 1604 W. Rosedale St., Suite 104, Fort Worth, TX 76104, USA;2. Yale School of Medicine, 333 Cedar St., New Haven, CT, 06510;3. Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611;1. Department of Surgery, Acute Care Surgery Division, USA;2. Department of Neurology, University of Iowa, Iowa City, IA, USA;1. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA;2. Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA;3. Section of Cardiac Surgery, University of Chicago, Chicago, IL, USA;4. Department of Anesthesia & Critical Care, University of Chicago, Chicago, IL, USA;1. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;2. Division of Plastic Surgery, Madison School of Medicine &Public Health, University of Wisconsin, Madison, WI, USA;3. Division of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;1. Anaesthesia and Critical Care Department, Tours University Hospital, Tours, France;2. Maxillofacial and Plastic Surgery Department, Tours University Hospital, Tours, France;3. Hepatogastroenterology Department, Tours University Hospital, Tours, France;4. N2C, Inserm, UMR1069, Université de Tours, Tours, France;5. Therapeutiques Anti-infectieuses, Université de Nantes, CHU Nantes, EA3826, France;6. Anaesthesia and Critical Care Department, Nantes University Hospital, Nantes, France;7. UMR 1253, iBrain, Université de Tours, Inserm, Tours, France;1. School of Medicine, University of Texas Medical Branch, Galveston, United States;2. Department of Surgery, University of Texas Medical Branch, Galveston, United States;3. Department of Pharmacology, University of Texas Medical Branch, Galveston, United States |
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| Abstract: | Burn injury causes a coagulopathy that is poorly understood. After severe burns, significant fluid losses are managed by aggressive resuscitation that can lead to hemodilution. These injuries are managed by early excision and grafting, which can cause significant bleeding and further decrease blood cell concentration. Tranexamic acid (TXA) is an anti-fibrinolytic that has been shown to reduce surgical blood losses; however, its use in burn surgery is not well established. We performed a systematic review and meta-analysis to investigate the influence TXA may have on burn surgery outcomes. Eight papers were included, with outcomes considered in a random-effects model meta-analysis. Overall, when compared to the control group, TXA significantly reduced total volume blood loss (mean difference (MD) = −192.44; 95% confidence interval (CI) = −297.73 to − 87.14; P = 0.0003), the ratio of blood loss to burn injury total body surface area (TBSA) (MD = −7.31; 95% CI = −10.77 to −3.84; P 0.0001), blood loss per unit area treated (MD = −0.59; 95% CI = −0.97 to −0.20; P = 0.003), and the number of patients receiving a transfusion intraoperatively (risk difference (RD) = −0.16; 95% CI = −0.32 to − 0.01; P = 0.04). Additionally, there were no noticeable differences in venous thromboembolism (VTE) events (RD = 0.00; 95% CI = −0.03 to 0.03; P = 0.98) and mortality (RD = 0.00; 95% CI = −0.03 to 0.04; P = 0.86). In conclusion, TXA can potentially be a pharmacologic intervention that reduces blood losses and transfusions in burn surgery without increasing the risk of VTE events or mortality. |
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| Keywords: | Tranexamic Acid Burn Surgery Hemostasis Blood loss Blood product transfusion |
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