Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos
Introducción: Los antifibrinolíticos análogos de lisina (LAAF), como el ácido tranexámico (TXA) y el ácido épsilon-aminocapróico (EACA), ayudan a reducir la pérdida de sangre en cirugía cardíaca de alto riesgo. Estos agentes inhiben la fibrinólisis, disminuyendo el sangrado y la necesidad de transfu...
- Autores:
- Tipo de recurso:
- Fecha de publicación:
- 2025
- Institución:
- Universidad del Rosario
- Repositorio:
- Repositorio EdocUR - U. Rosario
- Idioma:
- spa
- OAI Identifier:
- oai:repository.urosario.edu.co:10336/44748
- Acceso en línea:
- https://doi.org/10.48713/10336_44748
https://repository.urosario.edu.co/handle/10336/44748
- Palabra clave:
- Cirugía cardíaca
Ácido tranexámico
Ácido épsilon-aminocapróico
Análogos de lisina
Tópico
Sangrado
Cardiac surgery
Tranexamic acid
Aminocaproic acid
Lysine analogs
Topical
Bleeding
- Rights
- License
- Attribution-NoDerivatives 4.0 International
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EDOCUR2_5f1a3e532ad8cfb4689534803cb6e8a3 |
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oai:repository.urosario.edu.co:10336/44748 |
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EDOCUR2 |
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Repositorio EdocUR - U. Rosario |
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|
| dc.title.none.fl_str_mv |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| dc.title.TranslatedTitle.none.fl_str_mv |
Evaluating Topical Lysine Analogue Antifibrinolytics in Cardiac Surgery: A Systematic Review, Meta-Analysis and Trial Sequential Analysis |
| title |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| spellingShingle |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos Cirugía cardíaca Ácido tranexámico Ácido épsilon-aminocapróico Análogos de lisina Tópico Sangrado Cardiac surgery Tranexamic acid Aminocaproic acid Lysine analogs Topical Bleeding |
| title_short |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| title_full |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| title_fullStr |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| title_full_unstemmed |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| title_sort |
Evaluación de los antifibrinolíticos tópicos en cirugía cardíaca: revisión sistemática, metaanálisis y análisis secuencial de ensayos |
| dc.contributor.advisor.none.fl_str_mv |
Montoya Beltrán, Juan Sebastián Ramírez Herrera, Laura |
| dc.subject.none.fl_str_mv |
Cirugía cardíaca Ácido tranexámico Ácido épsilon-aminocapróico Análogos de lisina Tópico Sangrado |
| topic |
Cirugía cardíaca Ácido tranexámico Ácido épsilon-aminocapróico Análogos de lisina Tópico Sangrado Cardiac surgery Tranexamic acid Aminocaproic acid Lysine analogs Topical Bleeding |
| dc.subject.keyword.none.fl_str_mv |
Cardiac surgery Tranexamic acid Aminocaproic acid Lysine analogs Topical Bleeding |
| description |
Introducción: Los antifibrinolíticos análogos de lisina (LAAF), como el ácido tranexámico (TXA) y el ácido épsilon-aminocapróico (EACA), ayudan a reducir la pérdida de sangre en cirugía cardíaca de alto riesgo. Estos agentes inhiben la fibrinólisis, disminuyendo el sangrado y la necesidad de transfusiones, lo cual reduce el riesgo de infecciones, estancia hospitalaria prolongada, morbilidad y mortalidad. Aunque la administración intravenosa está respaldada, el uso tópico de LAAF podría mejorar la hemostasia, aunque la evidencia es limitada. Métodos: Se realizaron búsquedas en Pubmed, Embase, MEDLINE, Cochrane CENTRAL y Clarivate WoS hasta el 31 de agosto de 2024, de estudios que compararan TXA o EACA tópicos con placebo en cirugía cardíaca. La extracción de datos se realizó independientemente, evaluando la calidad con RoB2/ROBINS-I. Se utilizó un modelo de efectos aleatorios de derSimmonian-Laird y análisis de sensibilidad y secuencial de pruebas. Resultados: El metaanálisis incluyó 26 estudios con 2,624 pacientes, en su mayoría adultos, sometidos a bypass de arteria coronaria (CABG) y cirugías valvulares. El LAAF redujo la pérdida de sangre postoperatoria en 174 mL (p < 0.00001), el volumen de PRBC (DM -0.6 unidades, p = 0.00006) y los requerimientos de PFC (RR 0.69, p = 0.03). No hubo diferencias significativas en las tasas de complicaciones, aunque se observó alta heterogeneidad. Conclusión: La administración tópica de LAAF disminuye la pérdida de sangre postoperatoria y los volúmenes de transfusión de PRBC y PFC sin aumentar el riesgo de complicaciones. Registro: PROSPERO CRD42024579777 |
| publishDate |
2025 |
| dc.date.accessioned.none.fl_str_mv |
2025-01-20T17:52:40Z |
| dc.date.available.none.fl_str_mv |
2025-01-20T17:52:40Z |
| dc.date.created.none.fl_str_mv |
2025-01-16 |
| dc.type.none.fl_str_mv |
bachelorThesis |
| dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_7a1f |
| dc.type.spa.none.fl_str_mv |
Meta-análisis |
| dc.identifier.doi.none.fl_str_mv |
https://doi.org/10.48713/10336_44748 |
| dc.identifier.uri.none.fl_str_mv |
https://repository.urosario.edu.co/handle/10336/44748 |
| url |
https://doi.org/10.48713/10336_44748 https://repository.urosario.edu.co/handle/10336/44748 |
| dc.language.iso.none.fl_str_mv |
spa |
| language |
spa |
| dc.rights.*.fl_str_mv |
Attribution-NoDerivatives 4.0 International |
| dc.rights.coar.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 |
| dc.rights.acceso.none.fl_str_mv |
Abierto (Texto Completo) |
| dc.rights.uri.*.fl_str_mv |
http://creativecommons.org/licenses/by-nd/4.0/ |
| rights_invalid_str_mv |
Attribution-NoDerivatives 4.0 International Abierto (Texto Completo) http://creativecommons.org/licenses/by-nd/4.0/ http://purl.org/coar/access_right/c_abf2 |
| dc.format.extent.none.fl_str_mv |
98 pp |
| dc.format.mimetype.none.fl_str_mv |
application/pdf |
| dc.publisher.none.fl_str_mv |
Universidad del Rosario |
| dc.publisher.department.none.fl_str_mv |
Escuela de Medicina y Ciencias de la Salud |
| dc.publisher.program.none.fl_str_mv |
Especialización en Anestesia Cardiotorácica Especialización en Anestesiología FCI |
| publisher.none.fl_str_mv |
Universidad del Rosario |
| institution |
Universidad del Rosario |
| dc.source.bibliographicCitation.none.fl_str_mv |
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Vol. 20; No. 6; pp. 658 - 62; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23284106. Disponible en: 10.1177/0218492312441472. Abrishami, Amir; Chung, Frances; Wong, Jean (2009) Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis. En: Canadian journal of anaesthesia = Journal canadien d'anesthesie. Vol. 56; No. 3; pp. 202 - 12; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19247741. Disponible en: 10.1007/s12630-008-9038-x. Rampure Vittal Rao, Anand; Anakapalli, Muralidhar (2018) CAN TOPICAL TRANEXAMIC ACID APPLICATION ON PUMP CORONARY ARTERY BYPASS GRAFT SURGERY REDUCE POSTOPERATIVE BLOOD LOSS. En: Journal of Evolution of Medical and Dental Sciences. Vol. 7; No. 05; pp. 571 - 573; Akshantala Enterprises Private Limited; Disponible en: https://www.jemds.com/data_pdf/anand%20rampure--jan-29-.pdf. Disponible en: 10.14260/jemds/2018/130. Rostami, Alireza; Hoseini, AminHaj; Kamali, Alireza (2020) The effect of tranexamic acid in reducing postoperative hemorrhage in patients undergoing coronary artery bypass graft. En: Saudi Journal of Anaesthesia. Vol. 14; No. 4; pp. 431 - 431; Wolters Kluwer Medknow Publications; Disponible en: https://journals.lww.com/10.4103/sja.SJA_800_19. Disponible en: 10.4103/sja.SJA_800_19. Prokopchuk-Gauk, Oksana; Rosin, Mark W; Mycyk, Taras R; Lim, Hyun J; Brose, Kelsey (2016) Dual-route tranexamic acid to reduce blood loss in coronary artery bypass graft surgery: a randomized controlled trial. En: Canadian journal of anaesthesia = Journal canadien d'anesthesie. Vol. 63; No. 9; pp. 1110 - 1; Springer New York LLC; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/27334724. Disponible en: 10.1007/s12630-016-0684-0. Ali Shah, Muhammad Usman; Asghar, Muhammad Imran; Siddiqi, Rashad; Chaudhri, Muhammad Sohail; Janjua, Asif Mahmood; Iqbal, Afsheen (2015) Topical application of tranexamic acid reduces postoperative bleeding in open-heart surgery: myth or fact?. En: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. Vol. 25; No. 3; pp. 161 - 5; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25772953. Chaudhary, Farid Ahmad; Pervaz, Zahid; Ilyas, Sana; Niaz, Muhammad Nabeel (2018) Topical use of tranexamic acid in open heart surgery. En: JPMA. The Journal of the Pakistan Medical Association. Vol. 68; No. 4; pp. 538 - 542; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/29808041. Spegar, Jan; Vanek, Tomas; Snircova, Jana (2011) Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study. En: Journal of Cardiothoracic and Vascular Anesthesia. 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Montoya Beltrán, Juan Sebastián495b61a0-1ece-4d4e-a5f1-3b7ede290e97-1Ramírez Herrera, Laura0f154932-1841-4d47-9e7e-191b063f0404-1Herazo Cubillos, Andrés FelipePinilla Ojeda, Jorge LeandroMontoya Beltrán, Juan SebastiánRamírez Herrera, LauraEspecialista en Anestesia CardiotorácicaEspecialista en AnestesiologíaMaestríadfd2dea6-6bf8-49bc-b08d-a7671a6a157d-1cf52c143-9d31-4f44-93d2-b9a612b6870a38595102-08ad-4842-aea5-d9a2d14abc66-1347c5e8e-a682-4b90-a6da-26825d20a06b-12025-01-20T17:52:40Z2025-01-20T17:52:40Z2025-01-16Introducción: Los antifibrinolíticos análogos de lisina (LAAF), como el ácido tranexámico (TXA) y el ácido épsilon-aminocapróico (EACA), ayudan a reducir la pérdida de sangre en cirugía cardíaca de alto riesgo. Estos agentes inhiben la fibrinólisis, disminuyendo el sangrado y la necesidad de transfusiones, lo cual reduce el riesgo de infecciones, estancia hospitalaria prolongada, morbilidad y mortalidad. Aunque la administración intravenosa está respaldada, el uso tópico de LAAF podría mejorar la hemostasia, aunque la evidencia es limitada. Métodos: Se realizaron búsquedas en Pubmed, Embase, MEDLINE, Cochrane CENTRAL y Clarivate WoS hasta el 31 de agosto de 2024, de estudios que compararan TXA o EACA tópicos con placebo en cirugía cardíaca. La extracción de datos se realizó independientemente, evaluando la calidad con RoB2/ROBINS-I. Se utilizó un modelo de efectos aleatorios de derSimmonian-Laird y análisis de sensibilidad y secuencial de pruebas. Resultados: El metaanálisis incluyó 26 estudios con 2,624 pacientes, en su mayoría adultos, sometidos a bypass de arteria coronaria (CABG) y cirugías valvulares. El LAAF redujo la pérdida de sangre postoperatoria en 174 mL (p < 0.00001), el volumen de PRBC (DM -0.6 unidades, p = 0.00006) y los requerimientos de PFC (RR 0.69, p = 0.03). No hubo diferencias significativas en las tasas de complicaciones, aunque se observó alta heterogeneidad. Conclusión: La administración tópica de LAAF disminuye la pérdida de sangre postoperatoria y los volúmenes de transfusión de PRBC y PFC sin aumentar el riesgo de complicaciones. Registro: PROSPERO CRD42024579777INTRODUCTION: Lysine analog antifibrinolytics (LAAF) like tranexamic acid (TXA) and aminocaproic acid (EACA) reduce intraoperative blood loss, especially in cardiac surgery where bleeding risks are high. These LAAF inhibit fibrinolysis and have been proven to decrease bleeding and transfusion volume. In cardiac surgery, frequent transfusions raise the risk of infections, extend hospital stays and reoperations, and carry higher morbidity and mortality. While intravenous administration is well-supported, topical LAAF application may further enhance hemostasis and improve outcomes, though evidence for topical use is less robust. METHODS: Pubmed, Embase, MEDLINE, Cochrane CENTRAL, and Clarivate WoS were searched from inception to August 31st, 2024, for randomized controlled trials and observational studies comparing topical TXA or EACA to placebo in cardiac surgery. Data extraction was done independently, and RoB2/ROBINS-I was used for quality assessment. A derSimmonian-Laird random-effects model was applied. Mean differences were used for continuous outcomes, and OR/RR was used for binary. I2 statistics measured heterogeneity. Sensitivity analysis and GOSH plotting assessed heterogeneity; trial sequential analysis was performed. Certainty of evidence followed GRADE guidelines. RESULTS: The meta-analysis included 26 studies with 2,624 patients, 24 focused on adults. Given the pragmatic approach for this meta-analysis, a wide variety of surgical procedures were included, with coronary artery bypass grafting (CABG) and valvular procedures being the most prevalent. LAAF administration reduced postoperative blood loss by 174 ml (MD -173.99, CI95 -238.20 to -109.78, p <0.00001), the effect remained constant through subgroup analysis (CABG, High vs Low-dose, Dual-route administration). No significant differences were found in transfusion rates for packed red blood cells (PRBC) and platelets, though LAAF reduced PRBC volume (MD -0.6 units, CI95 -0.88 to -0.24 p = 0.00006) and fresh frozen plasma (FFP) requirements (RR 0.69, CI95: 0.5 to 0.95, p = 0.03). No differences in hematological change scores and complication rates were observed. The analysis showed high heterogeneity, but the overall effect remained consistent. A trial sequential analysis suggests there is enough data to confirm this effect. CONCLUSION: Topical LAAF administration reduces postoperative blood loss up to 24 hours postoperatively, lessening PRBC transfusion volume and FFP transfusion rate without increasing complications. Registration: PROSPERO CRD42024579777, August 27th, 202498 ppapplication/pdfhttps://doi.org/10.48713/10336_44748https://repository.urosario.edu.co/handle/10336/44748spaUniversidad del RosarioEscuela de Medicina y Ciencias de la SaludEspecialización en Anestesia CardiotorácicaEspecialización en Anestesiología FCIAttribution-NoDerivatives 4.0 InternationalAbierto (Texto Completo)EL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. 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