Tranexamic acid use in sarcoma surgery patients: A systematic review and meta-analysis.

Autor: Giglio V; School of Medicine, University of Limerick, Limerick, Ireland., Gazendam A; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Farrukh H; Department of Surgery, McMaster University, Hamilton, Ontario, Canada., Griffin A; Department of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada., Ferguson P; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.; Department of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada., Wunder J; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.; Department of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada., Tsoi K; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.; Department of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Sep; Vol. 130 (3), pp. 594-603. Date of Electronic Publication: 2024 Jul 30.
DOI: 10.1002/jso.27793
Abstrakt: Introduction: Perioperative bleeding increases morbidity and mortality in sarcoma patients. Tranexamic acid (TXA), an antifibrinolytic, is widely utilized in non-sarcoma orthopaedic surgeries, but its adoption in sarcoma surgery is hindered by concerns about thrombotic events.
Methods: Searches in Ovid MEDLINE, EMBASE, and CENTRAL were performed without date restrictions. Inclusion criteria encompassed sarcoma patients undergoing surgery with TXA intervention. Two authors independently screened studies, resolved conflicts, and assessed biases.
Results: Eight studies met inclusion criteria, comprising 2142 patients. TXA administration varied in dose and timing across studies. Meta-analysis revealed significantly reduced mean blood loss with TXA of -462.5 mL ([95% confidence interval [CI: -596.7, -328.31], p < 0.001) but no difference in transfusion rates (odds ratio [OR] = 0.51 [95% CI: 0.14-1.89]) or venous thromboembolism events (OR = 0.93 [95% CI: 0.40, 2.16]). Study biases were predominantly moderate to high due to retrospective designs and lack of control for confounders. Quality of reporting varied, with limitations identified in outcome reporting and effect size estimation.
Conclusions: Despite evidence of reduced blood loss, the absence of prospective studies limits conclusive recommendations on TXA use in sarcoma surgery. Further research is warranted to determine optimal TXA regimens and assess safety concerns regarding thrombotic events in this patient population.
(© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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