Effectiveness and safety of antifibrinolytic agents in off-pump coronary artery bypass grafting: a systematic review and meta-analysis
Joao Lucas W.C. Marchesani, Matheus H. Leite e Silva, Matheus S. Thomaz, Davi B. Wolff, Emerson C.L. Almeida, Michelle D.S.S. Costa
Abstract
Background
Coronary Artery Bypass Grafting (CABG) is the most widely used cardiac intervention and can be accomplished without an extracorporeal circulation off-pump. The benefits of antifibrinolytics in off-pump CABG have yet to be demonstrated.
Methods
Randomized Controlled Trials (RCTs) and observational studies comparing the use of antifibrinolytic agents (tranexamic acid, aprotinin, and epsilon-aminocaproic) versus controls in patients undergoing off-pump CABG were searched in the PubMed, Embase, and Cochrane databases. Outcomes included thromboembolic events, in-hospital mortality, overall mortality, bleeding, Intensive Care Unit (ICU) length of stay, and blood product transfusions. Meta-analyses were conducted using the Inverse Variance method under a random-effects model, with p < 0.05 considered statistically significant.
Results
Of the 23,149 patients in 20 RCTs and seven observational studies, 51% received antifi-brinolytic agents (tranexamic acid or aprotinin). Observational and randomized designs were analyzed separately in primary subgroup analyses. Significant reduction was found for overall mortality (RR = 0.72; [95% CI 0.54−0.95]) in the RCT subgroup. Red-blood-cell transfusion requirements were reduced (RR = 0.65; [95% CI 0.53, 0.78]) as well as Platelets (RR = 0.59; [95% CI 0.41, 0.84]) and fresh-frozen-plasma (RR = 0.39; [95% CI 0.36, 0.42]) transfusion requirement. The RCT subgroup showed a reduction in thromboembolic events (RR = 0.55; [95% CI 0.39, 0.79]).
Conclusions
In off-pump CABG, antifibrinolytics reduced the need for blood transfusion while reducing thromboembolic events and overall mortality in RCT subgroups, while pooled analyses combining RCTs and observational studies did not demonstrate significant reductions.
Keywords
References
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Submitted date:
06/23/2025
Accepted date:
01/04/2026
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