# Perioperative tranexamic acid in burn surgery: systematic review and meta-analysis of randomized controlled trials

## TL;DR

This study finds that tranexamic acid reduces blood loss and transfusion needs during burn surgery, but more research is needed due to limited data.

## Contribution

First systematic review and meta-analysis evaluating TXA's efficacy in burn surgery.

## Key findings

- TXA reduced total blood loss by 183.93 mL compared to control groups.
- TXA decreased the need for packed red blood cell transfusions by 58%.
- TXA improved hematocrit and hemoglobin levels in burn patients.

## Abstract

Burn injuries often require surgery, posing challenges due to significant intraoperative blood loss and transfusion risks. Tranexamic Acid (TXA), an antifibrinolytic agent, stabilizes clots and reduces fibrinolysis, with proven efficacy in various surgical settings. However, the benefits in burn patients are yet to be established.

We performed a systematic review and meta-analysis. PubMed, Embase, and Cochrane databases were searched for Randomized Clinical Trials (RCTs) comparing TXA versus control in burned patients. Risk Ratios (RR) and Mean Differences (MD) with 95% CIs were computed for binary and continuous outcomes, respectively. The primary endpoint of interest was blood loss. Statistical analyses were performed using RStudio software (version 4.2.2). The certainty of the evidence was evaluated using the GRADE approach.

Four RCTs comprising 204 patients were included, with 102 (50%) assigned to the TXA group. The mean patient age across studies ranged from 32.15 to 39.70 years. TXA significantly reduced total blood loss (MD = -183.93 mL; 95% CI: -278.44 to -89.42; p < 0.01), need for packed red blood cell transfusions (RR = 0.42, 95% CI 0.26 to 0.66; p < 0.01), while also improving hematocrit (MD = 3.49%; 95% CI: 1.58 to 5.41; p < 0.01) and hemoglobin levels (MD = 0.87 g.dL-1; 95% CI: 0.35 to 1.39; p < 0.01).

In patients with burns, TXA was associated with reduced blood loss and packed cell transfusions. However, certainty is limited by the small number and heterogeneity of available trials

PROSPERO ID: CRD420251000356. Registered on 07 March 2025.