Efficacy and safety of haemostatic agents for patients receiving antiplatelet therapy before coronary artery bypass grafting: a protocol for a systematic review and network meta-analysis of randomised controlled trials.

INTRODUCTION

Most patients undergoing coronary artery bypass grafting (CABG) receive preoperative antiplatelet therapy to reduce ischaemic events but this increases perioperative bleeding and transfusion risk. Tranexamic acid, aminocaproic acid, aprotinin and desmopressin are commonly employed to reduce such risk; however, robust direct head-to-head comparative evidence remains limited in this specific population. Therefore, we will conduct a network meta-analysis (NMA) of randomised controlled trials (RCTs) to compare their relative efficacy and safety.

METHODS AND ANALYSIS: We will systematically search PubMed, Embase, Web of Science, Scopus and Cochrane Central Register of Controlled Trials from inception to 24 March 2026 for RCTs that compare these four agents versus placebo/standard care or head-to-head in adults receiving preoperative antiplatelet therapy for CABG. Two reviewers will independently screen studies, extract data and assess the risk of bias using the Risk of Bias Instrument for Use in SysTematic reviews-for Randomised Controlled Trials tool. Primary outcomes will be the total perioperative volume of blood loss and the proportion of patients receiving red blood cell transfusions. Secondary outcomes will include blood product transfusion volumes, reoperation rates for bleeding or cardiac tamponade, rates of composite thromboembolic events, all-cause mortality and incidence of acute kidney injury. Pairwise random-effects meta-analyses will be performed first followed by Bayesian NMA. Surface under the cumulative ranking curve for the outcomes of interest will be used to rank the competing interventions. The Confidence in Network Meta-Analysis framework will be used to assess the quality of evidence.

ETHICS AND DISSEMINATION: Ethical approval is not required. Findings will be submitted to a peer-reviewed journal and disseminated to support clinical decision-making.

PROSPERO REGISTRATION NUMBER: CRD420251235248.