Efficacy and Safety Profile of Low-Dose Tranexamic Acid Regimen in Cardiac Surgery: A Meta-Analysis

Introduction: Various dosing regimens of tranexamic acid have been reported to exhibit varying efficacy and safety profiles. Herein, we conducted a meta-analysis to evaluate the efficacy and safety of low-dose regimens in open-heart surgery. Methods: Three databases were systematically searched for randomized trials examining the bleeding reduction effect of tranexamic acid in open-heart surgery. The pooled data of the low-dose group was then compared with the control, high-dose, and epsilon aminocaproic acid groups. The boundary between the low-and high-dose groups was a bolus of 30 mg/kg followed by 16 mg/kg/hour. Results: The meta-analysis included 81 studies. The low-dose tranexamic acid regimen was associated with a decreased incidence of reoperation (risk ratio: 0.52; 95 confidence interval: 0.39�0.69; high quality of evidence), perioperative myocardial infarction (risk ratio: 0.64; 95 confidence interval: 0.43�0.95; high quality of evidence), the amount of postoperative bleeding in 24 hours, and the need for transfusion of packed red cells compared to control, without increasing the rates of mortality, venous thromboembolism, or stroke. Compared with the high-dose group, the low-dose group had a lower incidence of seizures and stroke. The low-dose of tranexamic acid group also showed significantly reduced postoperative bleeding; however, the cost of an increased risk of seizure events was higher in the low-dose group than in the epsilon aminocaproic acid group. Conclusion: Low-dose tranexamic acid effectively reduced bleeding, the risk of reoperation, and myocardial infarction without increasing the risk of adverse events. © 2025, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.