Evidence suggests that both tranexamic acid (TXA) and ulinastatin (ULI) possess anti-inflammatory and blood-conserving properties. This study aimed to determine whether combining TXA and ULI yields additional benefits for patients undergoing cardiac surgery compared with the use of either medicine alone. This systematic review was conducted through comprehensive searches of PubMed, the Cochrane Library, EMBASE, CBM, CNKI, and WANFANG Data from their inception to December 2024 to identify all relevant clinical trials. Data from sixteen studies, encompassing 1,617 subjects, were synthesised using a random-effects meta-analysis. Primary outcomes included perioperative blood loss and blood transfusion requirements. Secondary outcomes included perioperative haemoglobin levels, coagulation function, platelet counts, and postoperative complications. This meta-analysis demonstrated that combination therapy with ULI and TXA significantly reduced total postoperative bleeding volume and RBC transfusion requirements compared to ULI monotherapy in cardiac surgery. However, no significant difference was observed compared to TXA alone. The combined regimen better preserved postoperative coagulation function, leading to significant improvements in prothrombin time, activated partial thromboplastin time, and D-dimer levels. The combination strategy may allow for reduced dosages of each drug, potentially lowering the thrombogenic risk associated with TXA. No significant adverse events were reported in the included studies. Therefore, the combination of ULI and TXA exhibits a synergistic effect on haemostasis and preservation of coagulation function, representing an optimised strategy for blood management in cardiac surgery. Key Words: Ulinastatin, Tranexamic acid, Cardiac surgery, Bleeding, Transfusion.
Zhang et al. (Mon,) studied this question.