Risk of venous and arterial thrombosis in non-surgical patients receiving systemic tranexamic acid: A systematic review and meta-analysis

Antifibrinolytic agents such as tranexamic acid (TXA) are commonly used as adjunctive therapies to prevent and treat excessive bleeding. In non-surgical settings, TXA is known to reduce bleeding related mortality. However, impact of TXA use on thrombosis is uncertain. We systematically searched the MEDLINE, EMBASE, and CENTRAL databases from January 1985 to August 2018. Studies with the following characteristics were included: (i) RCT design; (ii) compared systemic (oral or intravenous) TXA for prevention or treatment of bleeding for non-surgical indications and placebo or no TXA, and (iii) reported thrombotic events or mortality. A Mantel-Haenzel, random-effects model was used to calculate risk ratios, and risk of bias was assessed using the Cochrane risk of bias tool. Our search identified 22 studies representing 49,538 patients. Those receiving TXA had a significantly lower risk of death from any cause (RR = 0.92; 95% CI = 0.87–0.98; I2 = 0%). There was no significant increase in the risk of stroke (RR = 1.10; 95% CI = 0.68–1.78; I2 = 31%), myocardial infarction (RR = 0.88; 95% CI = 0.43–1.84; I2 = 46%), pulmonary embolism (RR = 0.97; 95% CI = 0.75–1.26; I2 = 0%), or deep vein thrombosis (RR = 0.99; 95% CI = 0.70–1.41; I2 = 0%) from use of TXA. The results were similar when restricted to studies at low risk of bias. In our systematic review and meta-analysis, the use of tranexamic acid reduced all-cause mortality without increased risk of venous or arterial thrombotic complications. •Among non-surgical patients systemic Tranexamic Acid (TXA) usage was associated with an 8% reduction in all-cause mortality.•There was no increase in venous or arterial thrombotic events with the use of TXA.•These results persisted when restricted to studies at low risk of bias.