Efficacy and Safety of Tranexamic Acid in Noncardiac Arterial Procedures: A Systematic Review and Meta-Analysis

OBJECTIVES: Non-cardiac arterial procedures (NCAP) are associated with a high risk of bleeding. Tranexamic acid (TXA) is used among surgical disciplines to reduce blood loss, however its effectiveness and safety in NCAP remain unclear. This review evaluates the efficacy and safety of TXA during NCAP. METHODS: Systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Literature searches in PubMed, EMBASE, and Cochrane databases (October 2023 and October 2024) identified studies investigating TXA in open and endovascular NCAP. Meta-analyses were conducted using Cochrane's Review Manager. RESULTS: Five studies (n=4304) were identified. One randomized controlled trial of TXA in non-cardiac surgery (n=9535), including a vascular cohort (14.8%; n=699 TXA, n=700 placebo), showed lower composite bleeding outcomes in the overall cohort receiving TXA (9.5% vs 11.7%; p<0.001), but not in the vascular cohort (HR 0.85; 95%CI 0.64-1.13). Another trial found no difference in blood loss or transfusion rates in 100 patients undergoing open abdominal aortic aneurysm surgery. Both trials reported no increased cardiovascular or thrombo-embolic complications (TEC) or 30-day mortality. A prospective study showed similar thrombosis-related technical failure rates in traumatic vascular injury patients (TXA 6.3% vs 3.8%, p=0.14) and no significant differences in bleeding or hematoma (TXA 11.4% vs 4.3%, p=0.13). In 297 carotid endarterectomy (CEA) patients, TXA significantly reduced postoperative hematoma (7.9% vs 1.3%; p=0.01) without increasing TEC or stroke. TXA during an intraoperative hemostasis protocol during CEA (TXA n=8) reported similar results. Meta-analysis showed no significant differences in TEC (RR 1.10; 95%CI 0.71-1.70) or reoperation rates (RR 0.55; 95%CI 0.19-1.63). CONCLUSION: TXA does not increase the risk of TEC in NCAP. However, there is currently insufficient evidence that TXA reduces bleeding complications.