Tranexamic acid in cardiac surgery: a systematic review and meta-analysis (protocol)
Autor: | Craig Ainswoth, Ryan Zarychanski, Tim Karachi, Dominic Xiang Wang, Bram Rochwerg, Shannon M. Fernando, Jessica Spence, Kwadwo Kyeremanteng, Richard P. Whitlock, Emilie P. Belley-Côté, Ahmed Alenazy, Alison Fox-Robichaud, Thamer Alaifan |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
Antifibrinolytic medicine.drug_class seizure MEDLINE Blood Loss Surgical 030204 cardiovascular system & hematology Cardiovascular Medicine tranexamic acid law.invention 03 medical and health sciences 0302 clinical medicine systematic review Meta-Analysis as Topic law Antifibrinolytic agent medicine Protocol Humans 030212 general & internal medicine Cardiac Surgical Procedures Intensive care medicine Stroke business.industry General Medicine Perioperative medicine.disease bleeding Intensive care unit mortality Antifibrinolytic Agents meta-analysis Research Design Meta-analysis business Tranexamic acid cardiac surgery medicine.drug Systematic Reviews as Topic |
Zdroj: | BMJ Open |
ISSN: | 2044-6055 |
Popis: | IntroductionBleeding during cardiac surgery is associated with increased morbidity and mortality. Tranexamic acid is an antifibrinolytic with proven efficacy in major surgeries. Current clinical practice guidelines recommend intraoperative use in cardiac procedures. However, several complications have been reported with tranexamic acid including seizures. This review intends to summarise the evidence examining the efficacy and safety of tranexamic acid in patients undergoing cardiac surgery.Methods/designWe will search MEDLINE, Embase, PubMED, ACPJC, CINAHL and the Cochrane trial registry for eligible randomised controlled trials, the search dates for all databases will be from inception until 1 January 2019, investigating the perioperative use of topical and/or intravenous tranexamic acid as a stand-alone antifibrinolytic agent compared with placebo in patients undergoing open cardiac surgery. We categorised outcomes as patient critical or patient important. Selected patient-critical outcomes are: mortality (intensive care unit, hospital and 30-day endpoints), reoperation within 24 hours, postoperative bleeding requiring transfusion of packed red blood cells, myocardial infarction, stroke, pulmonary embolism, bowel infarction, upper or lower limb deep vein thrombosis and seizures. Those outcomes, we perceived as clinical experts to be most patient valued and patients were not involved in outcomes selection process. We will not apply publication date, language, journal or methodological quality restrictions. Two reviewers will independently screen and identify eligible studies using predefined eligibility criteria and then review full reports of all potentially relevant citations. A third reviewer will resolve disagreements if consensus cannot be achieved. We will present the results as relative risk with 95% CIs for dichotomous outcomes and as mean difference or standardised mean difference for continuous outcomes with 95% CIs. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publicationTrial registration numberCRD42018105904 |
Databáze: | OpenAIRE |
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