Reducing Red Blood Cell Transfusion in Orthopedic and Cardiac Surgeries with Antifibrinolytics: A Laboratory Medicine Best Practice Systematic Review and Meta-Analysis

Red Blood Cell Transfusion


To evaluate the effectiveness of antifibrinolytics tranexamic acid (TA), ε-aminocaproic acid (EACA), and aprotinin to decrease overuse of red blood cell transfusions in adult surgical and non-surgical patients.


This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practice (LMBP™) Systematic Review (A-6) method. Eligible studies were assessed for evidence of effectiveness of TA or EACA in reducing the number of patients transfused or the number of whole blood transfusions.


Seventy-two articles met LMBP™ inclusion criteria. Fifty-six studies assessed Topical, Intra-articular Injection, or Intravenous TA, 4 studied EACA, and 12 studied the effectiveness of aprotinin. The overall strength of the body of evidence of effectiveness for each of these practices was rated as high.


LMBP™ recommends the use of topical, intra-articular injection, or intravenous tranexamic acid and the use of ε-aminocaproic acid for reducing overuse of red blood cell transfusion.

AuthorsJH Derzon, N Clarke, A Alford, I Gross, A Shander, R Thurer.
JournalClinical Biochemistry
Therapeutic AreaHematology
Service AreaModeling & Meta-Analysis
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