Maria Christiane Valéria Braga Braile, Sofia Braile Sabino, Giovanni Braile Sternieri, Luiza Braile Verdi, Eliana Migliorini Mustafa, Victor Rodrigues Ribeiro Ferreira, Bethina Canaroli Sbardellini, Cibele Olegário Vianna Queiroz, Idiberto José Zotarelli Filho and Domingo Marcolino Braile
Introduction: In the context of heart surgery, minimizing blood loss during surgery is critical. Tranexamic acid (TA) is an antifibrinolytic agent that has been widely used in other surgical specialties, especially in cardiac. Severe bleeding after cardiac surgery occurs in 3.0 to 11.0% of cases and requires surgical re-exploration in around 5.0% of cases. Objective: Conducted a systematic review in order to present the main literary findings on the use of tranexamic acid in the context of cardiac surgery. Methods: Following literary search criteria with the use of the MeSH Terms that were cited in the item on "Search strategies", a total of 84 clinical studies that were submitted to the eligibility analysis were checked and after that, 22 studies were selected, following the rules of systematic review-PRISMA. Major findings: The findings of this meta-analysis suggest that intrapericardial use of TA in patients undergoing cardiac surgery may decrease bleeding postoperatively without increasing the risk of postoperative seizures. The target concentration of TA to effectively inhibit fibrinolysis during CPB is 10-20 μg/L. The most frequent adverse effects reported with the use of TA are minor gastrointestinal symptoms, such as nausea and vomiting, especially when given in high doses or injected rapidly. Conclusion: With the use of tranexamic acid, some issues such as the incidence of thrombotic complications still require better elucidation, as well as the route of topical administration. Some authors have recommended a beginning infusion of such drugs after full heparinization in myocardial revascularization surgery, arguing that such a practice does not alter the outcome in terms of bleeding and would reduce the incidence of thrombotic complications.
