The Effects of Tranexamic Acid on Renal Outcomes in Patients Undergoing Cardiovascular Surgery: A Systematic Review and Meta-Analysis Compliant With Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

OBJECTIVE

To assess how tranexamic acid (TXA) influences the renal outcomes of cardiovascular surgical patients.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

SETTING

The operating room.

PARTICIPANTS

Cardiovascular surgical patients.

INTERVENTIONS: TXA or placebo.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome of interest included the incidence of postoperative (PO) acute kidney injury (AKI). Secondary outcomes of interest included PO-serum creatinine (SCr) levels, PO-blood urea nitrogen (BUN) levels, intraoperative urine output volumes, the length of stay (LOS) in the intensive care unit, the LOS in the hospital, and the 30-day mortality rate postoperatively. A database search yielded 19 RCTs including 6,450 patients, and 3,280 patients were allocated to the TXA group and 3,170 to the control group (placebo). Meta-analysis suggested that TXA did not influence the incidence of PO-AKI (4.2% v 4.3%; odds ratio [OR], 0.96; 95% CI, 0.75-1.22; p = 0.72). Meta-analysis also demonstrated that PO-SCr levels (weighted mean difference [WMD], 2.38; 95% CI, -2.80 to 7.56; p = 0.37) and PO-BUN levels (WMD, -0.16; 95% CI, -0.92 to 0.61; p = 0.69) were comparable between the TXA group and the control group, and that TXA did not influence PO-SCr and PO-BUN levels. Additionally, TXA did not influence the incidence of patients' 30-day mortality postoperatively (1.1% v 1.6%; OR, 0.71; 95% CI, 0.46 to 1.09; p = 0.12).

CONCLUSIONS

This current study suggested that TXA administration did not influence renal outcomes in cardiovascular surgical patients.