Lessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies.

This new meta-analysis ascertains the efficacy of tranexamic acid (TA) in cardiac surgery patients. Actually, TA is an effective blood-conserving agent with a significantly lower risk of death, and possibly a lower propensity to cause postoperative myocardial infarction, than aprotinin. Its indiscriminate use since the withdrawal of aprotinin and inconsistent dosing regimens can potentially increase the likelihood of postoperative neurological complications especially in high-risk patients. The authors conclude that further studies are needed to clarify the association between TA and neurological dysfunction and to determine the appropriate dosage in cardiac patients.

– Charles-Marc Samama