Department of Medicine, McMaster University, Hamilton, Canada. Electronic address: firstname.lastname@example.org. Department of Medicine, McMaster University, Hamilton, Canada. Population Health Research Institute, McMaster University, Hamilton, Canada. Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, McMaster University, Hamilton, Canada.
BACKGROUND Antifibrinolytic agents such as tranexamic acid (TXA) are commonly used as adjunctive therapies to prevent and treat excessive bleeding. In non-surgical settings, TXA is known to reduce bleeding related mortality. However, impact of TXA use on thrombosis is uncertain. METHODS We systematically searched the MEDLINE, EMBASE, and CENTRAL databases from January 1985 to August 2018. Studies with the following
characteristics were included: (i) RCT design; (ii) compared systemic (oral or intravenous) TXA for prevention or treatment of bleeding for non-surgical indications and placebo or no TXA, and (iii) reported thrombotic events or mortality. A Mantel-Haenzel, random-effects model was used to calculate risk ratios, and risk of bias was assessed using the Cochrane risk of bias tool. RESULTS Our search identified 22 studies representing 49,538 patients. Those receiving TXA had a significantly lower risk of death from any cause (RR=0.92; 95% CI=0.87-0.98; I(2)=0%). There was no significant increase in the risk of stroke (RR=1.10; 95% CI=0.68-1.78; I(2)=31%), myocardial infarction (RR=0.88; 95% CI=0.43-1.84; I(2)=46%), pulmonary embolism (RR=0.97; 95% CI=0.75-1.26; I(2)=0%), or deep vein thrombosis (RR=0.99; 95% CI=0.70-1.41; I(2)=0%) from use of TXA. The results were similar when restricted to studies at low risk of bias. CONCLUSIONS In our systematic review and meta-analysis, the use of tranexamic acid reduced all-cause mortality without increased risk of venous or arterial thrombotic complications.