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Several blood bags filled with donated blood are lined up horizontally, each with a white label and attached tubing, ready for medical use or transfusion.

Reducing red blood cell transfusion in orthopedic and cardiac surgeries with antifibrinolytics: a laboratory medicine best practice systematic review and meta-analysis

Authors: J H Derzon, N Clarke, A Alford, I Gross, A Shander, R Thurer.

Published: Clinical Biochemistry, 2019

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Objectives

To evaluate the effectiveness of antifibrinolytics tranexamic acid (TA), ε-aminocaproic acid (EACA), and aprotinin to decrease overuse of red blood cell transfusions in adult surgical and non-surgical patients.

Methods

This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practice (LMBP™) Systematic Review (A-6) method. Eligible studies were assessed for evidence of effectiveness of TA or EACA in reducing the number of patients transfused or the number of whole blood transfusions.

Results

Seventy-two articles met LMBP™ inclusion criteria. Fifty-six studies assessed Topical, Intra-articular Injection, or Intravenous TA, 4 studied EACA, and 12 studied the effectiveness of aprotinin. The overall strength of the body of evidence of effectiveness for each of these practices was rated as high.

Conclusion

LMBP™ recommends the use of topical, intra-articular injection, or intravenous tranexamic acid and the use of ε-aminocaproic acid for reducing overuse of red blood cell transfusion.