Efficacy and Safety of the Use of Tranexamic Acid in Burn Patients: A Systematic Review and Meta-analysis

Background: Tranexamic acid (TXA) is a widely used antifibrinolytic agent proven to reduce bleeding in many surgical settings. Its application in burn surgery is emerging; however, existing studies lack a comprehensive synthesis, making clinical translation challenging. Methods: A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and registered on PROSPERO (ID: CRD42023443397). An electronic search of PubMed, Ovid MEDLINE, and Embase (August 2024) yielded 532 articles, of which 15 studies met the inclusion criteria. Eligible study designs included randomized controlled trials, observational studies, case reports/series, and conference abstracts. Data on total blood loss, blood loss per area excised, hemoglobin levels, intraoperative fluid use, packed red blood cell transfusions, length of stay (LOS), complications, and mortality were extracted. Meta-analyses were performed using R (v4.4.1), and outcomes were reported as standardized mean differences (SMDs) or proportions. Results: Meta-analysis of 7 studies on preoperative intravenous TXA demonstrated significant reductions in total blood loss (SMD –0.65; P = 0.0051), blood loss per area excised (SMD –3.66; P = 0.0069), intraoperative packed red blood cell units (SMD –0.48; P = 0.0019), and LOS (SMD –0.34; P = 0.0035). No significant differences were observed in any of the other outcomes. Data for topical TXA remain limited, although preliminary reports are encouraging. Conclusions: Preoperative intravenous TXA may reduce surgical blood loss and intraoperative transfusions. Studies support a favorable safety profile. However, its impact on graft survival and overall transfusion needs is uncertain. Further research is warranted to optimize dosing, explore topical administration, and clarify subgroup effects.