Evidence map›Paper›PMID 22611164›Full record

SynthesisBMJ (Clinical research ed.)2012

Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis.

Katharine Ker, Phil Edwards, Pablo Perel, Haleema Shakur, Ian Roberts

10 registry-linked trialsOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 10 registered trials, which are not on this map. Cited by 333 papers, 28 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
333citing papers in PubMed, 28 pooled it
28.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02911831 early_phase1completednot on this mapstarted 2016, after this paper: background citation

IV Tranexamic Acid Prior to Hysterectomy for Reduction of Intraoperative Blood Loss: A Randomized Placebo-Controlled Trial

TypeinterventionalSponsorNorthwestern UniversityRan2016 to 2022Enrolled71ConditionsHysterectomy, Blood Loss, SurgicalArmsTranexamic Acid, Sodium Chloride
NCT03069859 phase2unknown statusnot on this mapstarted 2018, after this paper: background citation

Prophylactic Use of Tranexamic Acid for Preventing Postpartum Hemorrhage: A Randomized, Double-blinded, Placebo-controlled Pilot Trial

TypeinterventionalSponsorSunnybrook Health Sciences CentreRan2018 to 2022Enrolled31ConditionsPost Partum HemorrhageArmsTXA (1g), Placebo (0.9% saline)
NCT03113253 phase4completednot on this mapstarted 2016, after this paper: background citation

The Effect of Tranexamic Acid (TXA) on Blood Loss in Burn Surgery - A Randomized, Double-Blinded Placebo-Controlled Trial

TypeinterventionalSponsorCentre Hospitalier Saint Joseph Saint Luc de LyonRan2016 to 2021Enrolled121ConditionsTranexamic Acid, Burns, Surgery, Wounds and InjuriesArmsTranexamic Acid, Placebo
NCT03825939 phase4terminatednot on this mapstarted 2015, after this paper: background citation

Evaluating the Use of Tranexamic Acid (TXA) in Total Joint Arthroplasty

TypeinterventionalSponsorNYU Langone HealthRan2015 to 2016Enrolled52ConditionsBlood LossArmsIntravenous Placebo, Intravenous Tranexamic Acid
NCT04918576 phase3unknown statusnot on this mapstarted 2022, after this paper: background citation

A Randomized Control Trial Evaluating the Use of Topical Tranexamic Acid in Bilateral Breast Reduction Surgery to Prevent Bleeding Complications

TypeinterventionalSponsorMcMaster UniversityRan2022 to 2024Enrolled106ConditionsHematoma Postoperative, Tranexamic AcidArmsTranexamic acid, Normal Saline
NCT04918589 phase3unknown statusnot on this mapstarted 2022, after this paper: background citation

Effects of Tranexamic Acid for Alloplastic Breast Reconstruction: A Randomized Control Trial

TypeinterventionalSponsorMcMaster UniversityRan2022 to 2024Enrolled106ConditionsHematoma Postoperative, Breast Cancer, Tranexamic AcidArmsTranexamic acid, Normal Saline
NCT04996368 nacompletednot on this mapstarted 2022, after this paper: background citation

A Randomized Comparison of Two Doses of Tranexamic Acid in Open-Heart Surgery

TypeinterventionalSponsorShahid Gangalal National Heart CentreRan2022 to 2022Enrolled120ConditionsDrug UseArmsTranexamic acid injection
NCT06427850 nanot yet recruitingnot on this mapstarted 2024, after this paper: background citation

Effect of Topical Tranexamic Acid on Postoperative Drainage in Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): A Randomized Controlled Trial

TypeinterventionalSponsorThanawan LongsuwanRan2024 to 2026Enrolled28ConditionsDegenerative Spine Diseases, Surgical WoundArmsTranexamic acid, Normal saline
NCT07131592 phase4recruitingnot on this mapstarted 2025, after this paper: background citation

The Effect of Tranexamic Acid on Drainage Volume and Time to Drain Removal in Reduction Mammaplasty Patients

TypeinterventionalSponsorMassachusetts General HospitalRan2025 to 2027Enrolled160ConditionsDrain Output After Breast Reduction Surgery, Breast ReductionsArmsIV TXA, Topical TXA, Topical saline
NCT07501884 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Reduction of Perioperative Blood Loss in Urethral Reconstruction Using Tranexamic Acid (REDUCER Trial): A Multicenter Pragmatic Randomized Study

TypeinterventionalSponsorAmjad Alwaal, MD, MSc, FRCSC, FACSRan2026 to 2028Enrolled40ConditionsUrethral Stricture, Urethral DiseasesArmsTranexamic Acid, Urethroplasty
3 · Its place in the literature

Who cites it

333 citing papers in PubMed, 28 syntheses or guidelines pooled it, 990 citations in OpenAlex.

  1. Guideline
  2. The Effectiveness of Tranexamic Acid in Pediatric Posttonsillectomy Hemorrhage (A Systematic Review and Meta-Analysis).Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026
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  11. Tranexamic acid for preventing postpartum haemorrhage after vaginal birth.The Cochrane database of systematic reviews · 2025
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273 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Katharine KerClinical Trials Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. katharine.ker@lshtm.ac.uk
Phil Edwards
Pablo Perel
Haleema Shakur
Ian Roberts
University of London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients.

designSystematic review and meta-analysis. DATA SOURCES: Cochrane central register of controlled trials, Medline, and Embase, from inception to September 2011, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of relevant articles. STUDY SELECTION: Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in surgical patients. Outcome measures of interest were the number of patients receiving a blood transfusion; the number of patients with a thromboembolic event (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism); and the number of deaths. Trials were included irrespective of language or publication status.

results129 trials, totalling 10,488 patients, carried out between 1972 and 2011 were included. Tranexamic acid reduced the probability of receiving a blood transfusion by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65; P<0.001). This effect remained when the analysis was restricted to trials using adequate allocation concealment (0.68, 0.62 to 0.74; P<0.001). The effect of tranexamic acid on myocardial infarction (0.68, 0.43 to 1.09; P = 0.11), stroke (1.14, 0.65 to 2.00; P = 0.65), deep vein thrombosis (0.86, 0.53 to 1.39; P = 0.54), and pulmonary embolism (0.61, 0.25 to 1.47; P=0.27) was uncertain. Fewer deaths occurred in the tranexamic acid group (0.61, 0.38 to 0.98; P = 0.04), although when the analysis was restricted to trials using adequate concealment there was considerable uncertainty (0.67, 0.33 to 1.34; P = 0.25). Cumulative meta-analysis showed that reliable evidence that tranexamic acid reduces the need for transfusion has been available for over 10 years.

conclusionsStrong evidence that tranexamic acid reduces blood transfusion in surgery has been available for many years. Further trials on the effect of tranexamic acid on blood transfusion are unlikely to add useful new information. However, the effect of tranexamic acid on thromboembolic events and mortality remains uncertain. Surgical patients should be made aware of this evidence so that they can make an informed choice.

Indexed as

Antifibrinolytic AgentsBlood Loss, SurgicalBlood TransfusionHumansMyocardial InfarctionRandomized Controlled Trials as TopicStrokeThromboembolismTranexamic AcidAntifibrinolytic AgentsTranexamic Acid

Identifiers

PMID22611164
PMCPMC3356857
OpenAlexW2107339086

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 4 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.