Comparison of the Efficacy and Safety of Tranexamic Acid Versus Aminocaproic Acid for Bleeding Prevention in Adult Surgical Patients Undergoing Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis

The objective of this endeavor was to analyze current evidence comparing tranexamic acid (TXA) with aminocaproic acid (EACA) to determine their relative efficacy and safety in adult patients undergoing cardiopulmonary bypass (CPB). A systematic review and meta-analysis were conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to assess randomized controlled trials comparing TXA with EACA in adult CPB. Studies were excluded if not randomized, did not directly compare TXA with EACA, or did not involve the adult CPB population. The primary efficacy endpoint was total blood loss in 24 hours (mL). Safety endpoints included the most commonly reported adverse events. The secondary efficacy endpoint was total units of packed red blood cells transfused (units). Nine randomized controlled trials were included. TXA had a statistically significant reduction in 24-hour blood loss compared with EACA [-0.21 (CI, -0.36 to -0.06), P = 0.0070]. TXA also had a statistically significant reduction in total packed red blood cells infused [-0.30 (CI -0.50 to -0.11), P = 0.0025]. There was no significant difference in neurological [1.48 (0.92-2.38), P = 0.9843], renal [0.99 (0.85-1.15), P = 0.2274], cardiac [1.08 (0.88-1.32), P = 0.2068], or thrombotic [1.00 (0.39-2.58), P = 0.4450] events. With synthesized evidence supporting TXA, this review can help guide practitioners to make informed recommendations regarding periprocedural care to minimize blood loss and maximize resource use. This analysis and review supports the preferential use of TXA over EACA in adults undergoing CPB.