Perioperative tranexamic acid in burn surgery: systematic review and meta-analysis of randomized controlled trials
Ácido tranexâmico perioperatório em cirurgia de queimados: revisão sistemática e metanálise de ensaios clínicos randomizados
Maria Eduarda Molinari, Ramon Huntermann, Julia C. Bernardi, Nicoly Fiorese Andrade, Gustavo Barbosa David, Nicolas Ramos, Caroline de Oliveira Fischer Bacca
Abstract
Background
Burn injuries often require surgery, posing challenges due to significant intraoperative blood loss and transfusion risks. Tranexamic Acid (TXA), an antifibrinolytic agent, stabilizes clots and reduces fibrinolysis, with proven efficacy in various surgical settings. However, the benefits in burn patients are yet to be established.
Methods
We performed a systematic review and meta-analysis. PubMed, Embase, and Cochrane databases were searched for Randomized Clinical Trials (RCTs) comparing TXA versus control in burned patients. Risk Ratios (RR) and Mean Differences (MD) with 95% CIs were computed for binary and continuous outcomes, respectively. The primary endpoint of interest was blood loss. Statistical analyses were performed using RStudio software (version 4.2.2). The certainty of the evidence was evaluated using the GRADE approach.
Results
Four RCTs comprising 204 patients were included, with 102 (50%) assigned to the TXA group. The mean patient age across studies ranged from 32.15 to 39.70 years. TXA significantly reduced total blood loss (MD = -183.93 mL; 95% CI: -278.44 to -89.42; p < 0.01), need for packed red blood cell transfusions (RR = 0.42, 95% CI 0.26 to 0.66; p < 0.01), while also improving hematocrit (MD = 3.49%; 95% CI: 1.58 to 5.41; p < 0.01) and hemoglobin levels (MD = 0.87 g.dL-1; 95% CI: 0.35 to 1.39; p < 0.01).
Conclusion
In patients with burns, TXA was associated with reduced blood loss and packed cell transfusions. However, certainty is limited by the small number and heterogeneity of available trials.
Registration
PROSPERO ID: CRD420251000356. Registered on 07 March 2025.
Keywords
Resumo
Introdução
Lesões por queimadura frequentemente requerem intervenção cirúrgica, apresentando desafios devido à significativa perda sanguínea intraoperatória e ao risco de transfusão. O ácido tranexâmico (TXA), um agente antifibrinolítico, estabiliza coágulos e reduz a fibrinólise, com eficácia comprovada em diversos contextos cirúrgicos. No entanto, seus benefícios em pacientes queimados ainda não estão estabelecidos.
Methods
Foi realizada uma revisão sistemática e metanálise. As bases PubMed, Embase e Cochrane foram pesquisadas em busca de Ensaios Clínicos Randomizados (ECRs) que comparassem TXA versus controle em pacientes queimados. Razões de risco (RR) e diferenças de médias (DM) com IC de 95% foram calculadas para desfechos binários e contínuos, respectivamente. O desfecho primário de interesse foi a perda sanguínea. As análises estatísticas foram realizadas utilizando o software RStudio (versão 4.2.2). A certeza da evidência foi avaliada pelo método GRADE.
Resultados
Foram incluídos quatro ECRs, totalizando 204 pacientes, dos quais 102 (50%) foram alocados no grupo TXA. A idade média dos pacientes entre os estudos variou de 32,15 a 39,70 anos. O TXA reduziu significativamente a perda sanguínea total (DM = -183,93 mL; IC 95%: -278,44 a -89,42; p < 0,01), a necessidade de transfusão de concentrado de hemácias (RR = 0,42; IC 95%: 0,26 a 0,66; p < 0,01), além de melhorar o hematócrito (DM = 3,49%; IC 95%: 1,58 a 5,41; p < 0,01) e os níveis de hemoglobina (DM = 0,87 g.dL⁻¹; IC 95%: 0,35 a 1,39; p < 0,01).
Conclusão
Em pacientes queimados, o uso de TXA esteve associado à redução da perda sanguínea e da necessidade de transfusão de concentrado de hemácias. No entanto, a certeza das evidências é limitada pelo pequeno número e pela heterogeneidade dos estudos disponíveis.
Registro
PROSPERO ID: CRD420251000356. Registrado em 07 de março de 2025.
Palavras-chave
Referencias
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Submitted date:
16/07/2025
Accepted date:
16/12/2025
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