Optimizing blood management in burn surgery: a meta-analysis of tranexamic acid vs. placebo

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BACKGROUND: Early debridement and grafting improve burn outcomes but pose significant blood loss risks. Tranexamic acid (TXA), an antifibrinolytic agent, reduces hemorrhage without increasing Venous thromboembolism (VTE) risk. While widely used in other surgeries, its role in burn surgery remains unclear. This meta-analysis evaluates TXA's efficacy in improving surgical outcomes in burn patients. METHODS: We searched PubMed, Scopus, Web of Science, Cochrane, and Springer databases (last search: February 2025). Eligible RCTs compared TXA vs. placebo in burn surgery. Primary outcomes included blood loss (ml), transfusion need, hemoglobin change (g/dL), and hematocrit change (%). We conducted sensitivity, cumulative, and meta-regression analysis for all outcomes and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for primary outcomes. RESULTS: We included five studies containing 227 patients. TXA significantly reduced operative blood loss (MD: -181.52 mL; p = 0.00; moderate certainty; I² = 61.46%) and transfusion need (RR: 0.52; p = 0.01; moderate certainty; I² = 0%). However, TXA did not significantly affect changes in hemoglobin (MD: 0.06; p = 0.94; low certainty; I² = 91.29%) or hematocrit levels (MD: 0.19; p = 0.90; very low certainty; I² = 88.94%). CONCLUSION: TXA significantly reduces total operative blood loss and transfusion needs with moderate certainty. However, it does not significantly impact hemoglobin or hematocrit levels. Secondary outcomes showed no significant differences, including operative time, hospitalization length, and infection rates. TRIAL REGISTRATION: Not applicable.

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