Early debridement and grafting continue to be the gold standard for treating burn patients as it has been demonstrated to increase graft success rates, lower infection risks, and lessen the chance of sepsis and multi-organ failure. The antifibrinolytic drug tranexamic acid decreases bleeding without raising the risk of venous thromboembolism (VTE). Its function in burn surgery is yet unknown, despite its widespread usage in other procedures. Therefore, to assess the effectiveness of TXA in enhancing surgical outcomes for burn patients, Mohamed Abdo Khalafallah and team carried out this meta-analysis.
This research looked through the databases of Springer, Web of Science, Cochrane, PubMed, and Scopus (latest search: February 2025). Hemoglobin change (g/dL), hematocrit change (%), transfusion requirement, and blood loss (ml) were the main outcomes. They performed Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for key outcomes and sensitivity, cumulative, and meta-regression analysis for all outcomes.
5 trials with a total of 227 patients were included. TXA substantially decreased the requirement for transfusions (RR: 0.52; p = 0.01; moderate certainty; I² = 0%) and surgical blood loss (MD: -181.52 mL; p = 0.00; intermediate certainty; I² = 61.46%). TXA did not, however, substantially alter hematocrit levels (MD: 0.19; p = 0.90; very low certainty; I² = 88.94%) or hemoglobin levels (MD: 0.06; p = 0.94; low certainty; I² = 91.29%).
Overall, through the exclusive inclusion of RCTs, this meta-analysis provides additional evidence that TXA dramatically lowers transfusion needs and total operational blood loss in burn surgery patients, which is consistent with earlier studies. However, because of the high heterogeneity among the included studies and the limited statistical power, the results pertaining to secondary outcomes, including intraoperative fluid use, postoperative infections, hospital length of stay, operative time, and total PRBC transfusion, should be interpreted cautiously. Since the present body of evidence is restricted by the small dataset and the variation in study designs, clinicians should use caution when extrapolating these findings to a variety of clinical scenarios.
Source:
Khalafallah, M. A., Elsead, J. A., Aboud, F. A., Koraim, B. M., & Elhois, I. S. (2025). Optimizing blood management in burn surgery: a meta-analysis of tranexamic acid vs. placebo. BMC Surgery, 25(1), 294. https://doi.org/10.1186/s12893-025-03014-4
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