Evidence map›Paper›PMID 38587333›Full record

Trial reportCirculation2024

Topical Versus Intravenous Tranexamic Acid in Patients Undergoing Cardiac Surgery: The DEPOSITION Randomized Controlled Trial.

André Lamy, Dmitry A Sirota, Frederic Jacques, Ahmad Poostizadeh, Nicolas Noiseux, Sergey Efremov, Philippe Demers, Boris Akselrod, Chew Yin Wang, Rakesh C Arora and 20 more

2 registry-linked trialsAbstract readRandomized Controlled TrialMulticenter StudyComparative Study
PubMed Publisher
In one paragraph

Trial report in Circulation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 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.

NCT03954314 phase3terminatednot on this map

Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic Acid in Open Cardiac Surgery (DEPOSITION) Study

TypeinterventionalSponsorPopulation Health Research InstituteRan2019 to 2023Enrolled3,242ConditionsBleeding, Surgical Blood Loss, SeizuresArmsTranexamic Acid
NCT06622564 phase3not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Decreasing Postoperative Blood Loss and Seizures by Timing of Intravenous Tranexamic Acid in Open Cardiac Surgery (DEPOSITION)-2 Pilot Trial

TypeinterventionalSponsorHamilton Health Sciences CorporationRan2025 to 2026Enrolled40ConditionsBleeding, Surgical Blood Loss, SeizuresArmsBefore CPB Tranexamic Acid, After CPB Tranexamic Acid, Before CPB Placebo, After CPB Placebo
3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. AnACS applied bio materials · 2025
    Article
  5. Article
  6. 2024 EACTS/EACTAIC Guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
    Article
  7. Article
  8. New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2024.European heart journal. Cardiovascular pharmacotherapy · 2025
    Review
  9. Article
  10. Article
  11. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

30 authors.

André LamyPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).ORCID 0000-0003-2777-7621
Dmitry A SirotaE. Meshalkin National Medical Research Center, Novosibirsk, Russia (D.A.S.).
Frederic JacquesInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada (F.J.).
Ahmad PoostizadehKelowna General Hospital, BC, Canada (A.P.).
Nicolas NoiseuxCentre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), QC, Canada (N.N.).
Sergey EfremovSaint Petersburg State University Hospital, Russia (S.E.).ORCID 0000-0001-5581-9169
Philippe DemersMontreal Heart Institute, University of Montréal, QC, Canada (P.D.).
Boris AkselrodPetrovsky National Centre of Surgery, Moscow, Russia (B.A.).
Chew Yin WangDepartment of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (C.Y.W.).ORCID 0000-0002-9066-3830
Rakesh C AroraDivision of Cardiac Surgery, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (R.C.A.).ORCID 0000-0002-5799-3619
Piotr BrannyDepartment of Cardiac Surgery, Hospital Agel Trinec-Podlesi, Trinec, Czech Republic (P.B.).
Shay P McGuinnessAuckland City Hospital, New Zealand (S.P.M.).
Craig D BrownNew Brunswick Heart Centre, Saint John, Canada (C.D.B.).ORCID 0000-0002-6077-7263
Hugues JeanmartCentre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, QC, Canada (H.J.).
Qiang ZhaoRujin Hospital, Shanghai, China (Q.Z.).ORCID 0000-0002-8930-3854
Haibo ZhangBeijing Anzhen Hospital, China (H.Z.).ORCID 0000-0001-7249-3113
Emilie P Belley-CôtéPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).ORCID 0000-0002-5071-076X
Richard P WhitlockPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).ORCID 0000-0002-6863-5884
Austin BrowneHamilton Health Sciences, Hamilton General Hospital, Ontario, Canada (A.B.).
Ingrid CoplandPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).
Jessica VincentPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).ORCID 0000-0002-2356-8876
Rutaba KhatunPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).
Kumar BalasubramanianPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).
Shrikant I BangdiwalaPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).ORCID 0000-0002-3111-0689
Michael H McGillionPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).
Alison E Fox-RobichaudMedicine (E.P.B-C., A.E.F-B., S.Y., P.J.D.), McMaster University, Hamilton, ON, Canada.ORCID 0000-0001-9912-3606
Jessica SpencePopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).
Salim YusufPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).ORCID 0000-0003-4776-5601
P J DevereauxORCID 0000-0003-2935-637X
DEPOSITION Study GroupPopulation Health Research Institute, Hamilton, ON, Canada (A.L., E.P.B-C., R.P.W., I.C., J.V., R.K., K.B., S.I.B., M.H.M., J.S., S.Y., P.J.D.).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough intravenous tranexamic acid is used in cardiac surgery to reduce bleeding and transfusion, topical tranexamic acid results in lower plasma concentrations compared with intravenous tranexamic acid, which may lower the risk of seizures. We aimed to determine whether topical tranexamic acid reduces the risk of in-hospital seizure without increasing the risk of transfusion among cardiac surgery patients.

methodsWe conducted a multicenter, double dummy, blinded, randomized controlled trial of patients recruited by convenience sampling in academic hospitals undergoing cardiac surgery with cardiopulmonary bypass. Between September 17, 2019, and November 28, 2023, a total of 3242 patients from 16 hospitals in 6 countries were randomly assigned (1:1 ratio) to receive either intravenous tranexamic acid (control) through surgery or topical tranexamic acid (treatment) at the end of surgery. The primary outcome was seizure, and the secondary outcome was red blood cell transfusion. After the last planned interim analysis, when 75% of anticipated participants had completed follow up, the data and safety monitoring board recommended to terminate the trial, and upon unblinding, the operations committee stopped the trial for safety.

resultsAmong 3242 randomized patients (mean age, 66.0 years; 77.7% male), in-hospital seizure occurred in 4 of 1624 patients (0.2%) in the topical group, and 11 of 1628 patients (0.7%) in the intravenous group (absolute risk difference, -0.5% [95% CI, -0.9 to 0.03];

conclusionsAmong patients undergoing cardiac surgery, topical administration of tranexamic acid resulted in an 8.3% absolute increase in transfusion without reducing the incidence of seizure, compared with intravenous tranexamic acid. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03954314.

Indexed as

Administration, IntravenousAdministration, TopicalAntifibrinolytic AgentsCardiac Surgical ProceduresTranexamic AcidAgedBlood Loss, SurgicalDouble-Blind MethodFemaleHumansMaleMiddle AgedSeizuresTreatment OutcomeAntifibrinolytic AgentsTranexamic Acidadministration, intravenousadministration, topicalblood transfusionseizuresthoracic surgerytranexamic acid

Identifiers

PMID38587333

What OpenQuestion holds

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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.