Hemostatic Effect and Safety of TXA: An Umbrella Review

Aim: To evaluate the hemostatic effect and safety of TXA. Methods: Meta-analyses were retrieved from databases. Risk ratios (RR), odds ratios (OR), weighted mean difference (WMD), standard mean difference (SMD) and 95% confidence intervals (CI) were extracted to compare the effeteness of TXA in reducing TBL, transfusion rate, Hb drop, mortality, DVT, PE. Results: In total, 136 trials (396 comparisons) including 17 kinds of surgeries were retrieved. The evidence for TXA using in total knee arthroplasty (TKA), total hip arthroplasty (THA), postpartum bleeding, intertrochanteric fractures, orthopaedic surgery, spinal surgery, shoulder arthroplasty, hip fracture surgery, cardiac surgery, menstrual bleeding, plastic surgery, myomectomy, nasal surgery was assessed as possible for the association of reducing TBL. The evidence for TXA using in TKA, THA, postpartum bleeding, orthopaedic surgery, shoulder arthroplasty was assessed as probable for the association of reducing transfusion rate. The evidence for TXA using in liver surgery, spinal surgery, hip fracture surgery, cancer, cardiac surgery was considered to be possible for the association of reducing transfusion rate. The evidence for TXA using in intertrochanteric fractures, orthopaedic surgery, hip fracture surgery was assessed as probable for the association of reducing Hb drop. The evidence for TXA using in TKA, THA, postpartum bleeding, shoulder arthroplasty was considered to be possible for the association of reducing Hb drop. The evidence for TXA using in trauma, gastrointestinal bleeding was assessed as probable for the association of reducing mortality. Conclusion: This umbrella review indicated that TXA was regarded as effective to reduce TBL, transfusion rate, Hb drop, mortality, and did not increase the incidence of DVT and PE. However, more convincing evidence should be provided to further clarify the level of efficacy and safety of TXA.