Antifibrinolytics reduces blood loss in thoracic surgery: a systematic review and meta‐analysis

BACKGROUND The purpose of this systematic review is to evaluate the efficacy of antifibrinolytics in non-cardiac thoracic surgery. METHODS We searched for all randomized controlled trials on this topic. A set of strict inclusion and exclusion criteria was developed. Six studies were meta-analysed together then in subgroups of topical tranexamic acid and intravenous aprotinin. We compared postoperative chest drain output, transfusions requirements and duration of hospital stay where available to determine the efficacy of topical tranexamic acid or intravenous aprotinin in reducing blood loss. RESULTS The use of antifibrinolytics reduces 24-h chest drain output (-290.21 mL [-524.75, -55.66], P = 0.02, I2 = 98%), red blood cell transfusion requirements (-1.27 units [-2.24, -0.30], P = 0.01, I2 = 100%) and shortened duration of hospital stay (-1.81 days [-3.25, -0.36], P = 0.01, I2 = 96%). The subgroup analysis also supported this trend. CONCLUSION We conclude that the use of antifibrinolytics appears to reduce postoperative blood loss by reducing chest drain output, transfusion requirements and length of stay after thoracic surgery.