SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1643712
This article is part of the Research TopicSurgical Treatment and Perioperative Organ Protection for Coronary Heart Disease and Comorbid Chronic DiseasesView all 6 articles
The safety and efficacy of intravenous administration of tranexamic acid in off-pump coronary artery bypass grafting: a systematic review and meta‑analysis
Provisionally accepted
- 1Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
- 2Fuwai Yunnan Cardiovascular Hospital, Kunming, China
- 3Qujing Maternal and Child Health Care Hospital, Qujing, China
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Study Objective: To assess the efficacy and safety of tranexamic acid (TXA) on off-pump coronary artery bypass (OPCAB) surgery. Design: Meta-analysis. Methods: Relevant trials were identified by computerized searches of PUBMED, Cochrane Library, EMBASE, OVID, China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data till Aug 8th, 2024, were searched using search terms "Tranexamic acid", "coronary artery bypass grafting", "off-pump", "randomized controlled trial" database search was updated on Aug 10th, 2025. Primary outcomes included intraoperative and postoperative bleeding. Results: Nineteen randomized controlled trials were finally included in the current study. Intravenous TXA reduced intraoperative and postoperative bleeding volume (including 2-hour, 4-hour, 6-hour, and 24-hour postoperative bleeding). It also decreased the rate and volume of red blood cell (RBC) and fresh frozen plasma (FFP) transfusions, with no effect on reoperation rates due to postoperative bleeding. At 24 hours postoperatively, TXA increased platelet counts, hemoglobin concentrations, and prothrombin time (PT), while decreasing activated partial thromboplastin time (APTT), fibrinogen levels, and D-dimer concentrations. Importantly, TXA did not elevate the risk of postoperative complications (e.g., mortality, myocardial infarction, cerebrovascular accidents, thrombotic events) and had no impact on levels of CK-MB, creatinine, interleukin-6, or lengths of intensive care unit (ICU) and hospital stays. Conclusions: Intravenous TXA is effective in reducing perioperative bleeding and transfusion requirements in OPCAB without increasing the risk of major postoperative complications, supporting its clinical utility in this setting. More well-designed and adequately powered RCTs are needed to confirm this further.
Keywords: Coronary Artery Bypass, Off-pump, Tranexamic Acid, Postoperative Complications, coagulation
Received: 09 Jun 2025; Accepted: 26 Aug 2025.
Copyright: © 2025 Yao, Zou, Song, Zhang and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yun-tai Yao, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
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