Evidence map›Paper›PMID 34724964›Full record

SynthesisCritical care (London, England)2021

Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis.

Shuhei Murao, Hidekazu Nakata, Ian Roberts, Kazuma Yamakawa

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06427850 (Effect of Topical Tranexamic Acid on Postoperative Drainage in Minimally Invasive Transforaminal Lumbar Interbody Fusion), which is not on this map. Cited by 60 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
60citing papers in PubMed, 12 pooled it
–field-weighted citation impact
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.

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
3 · Its place in the literature

Who cites it

60 citing papers in PubMed, 12 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Tranexamic acid-induced anaphylaxis: a systematic review.European journal of clinical pharmacology · 2025
    Pooled it
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  5. Tranexamic acid for preventing postpartum haemorrhage after vaginal birth.The Cochrane database of systematic reviews · 2025
    Pooled it
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  10. Tranexamic acid for percutaneous nephrolithotomy.The Cochrane database of systematic reviews · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Shuhei MuraoDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
Hidekazu NakataDivision of Trauma and Surgical Critical Care, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Ian RobertsLondon School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
Kazuma YamakawaDepartment of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan. kazuma.yamakawa@ompu.ac.jp.ORCID http://orcid.org/0000-0003-2999-4021

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTranexamic acid (TXA) reduces surgical bleeding and reduces death from bleeding after trauma and childbirth. However, its effects on thrombotic events and seizures are less clear. We conducted a systematic review and meta-analysis to examine the safety of TXA in bleeding patients.

methodsFor this systematic review and meta-analysis, we searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials from inception until June 1, 2020. We included randomized trials comparing intravenous tranexamic acid and placebo or no intervention in bleeding patients. The primary outcomes were thrombotic events, venous thromboembolism, acute coronary syndrome, stroke and seizures. A meta-analysis was performed using a random effects model and meta-regression analysis was performed to evaluate how effects vary by dose. We assessed the certainty of evidence using the grading of recommendations, assessment, development and evaluations (GRADE) approach.

resultsA total of 234 studies with 102,681 patients were included in the meta-analysis. In bleeding patients, there was no evidence that TXA increased the risk of thrombotic events (RR = 1.00 [95% CI 0.93-1.08]), seizures (1.18 [0.91-1.53]), venous thromboembolism (1.04 [0.92-1.17]), acute coronary syndrome (0.88 [0.78-1.00]) or stroke (1.12 [0.98-1.27]). In a dose-by-dose sensitivity analysis, seizures were increased in patients receiving more than 2 g/day of TXA (3.05 [1.01-9.20]). Meta-regression showed an increased risk of seizures with increased dose of TXA (p = 0.011).

conclusionTranexamic acid did not appear to increase the risk of thrombotic events in bleeding patients. However, because there may be dose-dependent increase in the risk of seizures, very high doses should be avoided.

Indexed as

Antifibrinolytic AgentsHemorrhageTranexamic AcidAcute Coronary SyndromeHumansRisk AssessmentSeizuresStrokeTreatment OutcomeVenous ThromboembolismAntifibrinolytic AgentsTranexamic AcidBleedingMeta-analysisSeizureSurgeryThrombotic eventsTranexamic acid

Identifiers

PMID34724964
PMCPMC8561958

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Registered trials

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.