Breno G A S de Jesus, Eduardo S R Barreto, Gabriel S Medrado Nunes, Caio F Nascimento, Maria E M Vassoler, Felipe C A Meira, Eduardo F Viana
{"title":"氨甲环酸在肝脏手术中的安全性和有效性：一项随机对照试验的荟萃分析。","authors":"Breno G A S de Jesus, Eduardo S R Barreto, Gabriel S Medrado Nunes, Caio F Nascimento, Maria E M Vassoler, Felipe C A Meira, Eduardo F Viana","doi":"10.1016/j.hpb.2025.05.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hepatic surgeries involve substantial bleeding risk, associated with perioperative morbidity and mortality. While tranexamic acid (TXA) reduces blood loss in other surgeries, its efficacy in hepatic procedures remains unclear. This meta-analysis evaluates TXA's safety and effectiveness in liver surgeries.</p><p><strong>Methods: </strong>We systematically reviewed randomized controlled trials published until April 2025 from PubMed, Scopus, Embase, and Cochrane CENTRAL. Studies comparing TXA with placebo in adult elective liver surgeries were included. Primary outcomes were blood loss and mortality, while secondary outcomes encompassed blood transfusion needs, thromboembolic, and adverse events. The Cochrane Risk of Bias tool was used for quality assessment.</p><p><strong>Results: </strong>Six trials comprising 1875 patients undergoing liver resections or transplants were included. TXA did not reduce intraoperative blood loss (MD = -0.16 L; 95 % CI: -0.50 to 0.18; I<sup>2</sup> = 92 %) or mortality (RR = 1.04; 95 % CI: 0.58 to 1.87; I<sup>2</sup> = 4 %). Thromboembolic risk showed no significant difference overall (RR = 1.58; 95 % CI: 0.94 to 2.64; I<sup>2</sup> = 0 %), but sensitivity analysis indicated a potential increased risk (RR = 1.70; 95 % CI: 1.01 to 2.87).</p><p><strong>Conclusion: </strong>Our findings suggest that TXA does not improve bleeding or mortality outcomes in liver surgeries and may increase thromboembolic risk. (PROSPERO number, CRD42024585513).</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety and efficacy of tranexamic acid in hepatic surgery: a meta-analysis of randomized controlled trials.\",\"authors\":\"Breno G A S de Jesus, Eduardo S R Barreto, Gabriel S Medrado Nunes, Caio F Nascimento, Maria E M Vassoler, Felipe C A Meira, Eduardo F Viana\",\"doi\":\"10.1016/j.hpb.2025.05.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hepatic surgeries involve substantial bleeding risk, associated with perioperative morbidity and mortality. While tranexamic acid (TXA) reduces blood loss in other surgeries, its efficacy in hepatic procedures remains unclear. This meta-analysis evaluates TXA's safety and effectiveness in liver surgeries.</p><p><strong>Methods: </strong>We systematically reviewed randomized controlled trials published until April 2025 from PubMed, Scopus, Embase, and Cochrane CENTRAL. Studies comparing TXA with placebo in adult elective liver surgeries were included. Primary outcomes were blood loss and mortality, while secondary outcomes encompassed blood transfusion needs, thromboembolic, and adverse events. The Cochrane Risk of Bias tool was used for quality assessment.</p><p><strong>Results: </strong>Six trials comprising 1875 patients undergoing liver resections or transplants were included. TXA did not reduce intraoperative blood loss (MD = -0.16 L; 95 % CI: -0.50 to 0.18; I<sup>2</sup> = 92 %) or mortality (RR = 1.04; 95 % CI: 0.58 to 1.87; I<sup>2</sup> = 4 %). Thromboembolic risk showed no significant difference overall (RR = 1.58; 95 % CI: 0.94 to 2.64; I<sup>2</sup> = 0 %), but sensitivity analysis indicated a potential increased risk (RR = 1.70; 95 % CI: 1.01 to 2.87).</p><p><strong>Conclusion: </strong>Our findings suggest that TXA does not improve bleeding or mortality outcomes in liver surgeries and may increase thromboembolic risk. (PROSPERO number, CRD42024585513).</p>\",\"PeriodicalId\":13229,\"journal\":{\"name\":\"Hpb\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hpb\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hpb.2025.05.006\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hpb","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hpb.2025.05.006","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Safety and efficacy of tranexamic acid in hepatic surgery: a meta-analysis of randomized controlled trials.
Background: Hepatic surgeries involve substantial bleeding risk, associated with perioperative morbidity and mortality. While tranexamic acid (TXA) reduces blood loss in other surgeries, its efficacy in hepatic procedures remains unclear. This meta-analysis evaluates TXA's safety and effectiveness in liver surgeries.
Methods: We systematically reviewed randomized controlled trials published until April 2025 from PubMed, Scopus, Embase, and Cochrane CENTRAL. Studies comparing TXA with placebo in adult elective liver surgeries were included. Primary outcomes were blood loss and mortality, while secondary outcomes encompassed blood transfusion needs, thromboembolic, and adverse events. The Cochrane Risk of Bias tool was used for quality assessment.
Results: Six trials comprising 1875 patients undergoing liver resections or transplants were included. TXA did not reduce intraoperative blood loss (MD = -0.16 L; 95 % CI: -0.50 to 0.18; I2 = 92 %) or mortality (RR = 1.04; 95 % CI: 0.58 to 1.87; I2 = 4 %). Thromboembolic risk showed no significant difference overall (RR = 1.58; 95 % CI: 0.94 to 2.64; I2 = 0 %), but sensitivity analysis indicated a potential increased risk (RR = 1.70; 95 % CI: 1.01 to 2.87).
Conclusion: Our findings suggest that TXA does not improve bleeding or mortality outcomes in liver surgeries and may increase thromboembolic risk. (PROSPERO number, CRD42024585513).
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).
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