To assess how tranexamic acid (TXA) influences the renal outcomes of cardiovascular surgical patients.

Systematic review and meta-analysis of randomized controlled trials (RCTs).

The operating room.

Cardiovascular surgical patients.

TXA or placebo.

The primary outcome of interest included the incidence of postoperative (PO) acute kidney injury (AKI). Secondary outcomes of interest included PO–serum creatinine (SCr) levels, PO–blood urea nitrogen (BUN) levels, intraoperative urine output volumes, the length of stay (LOS) in the intensive care unit, the LOS in the hospital, and the 30-day mortality rate postoperatively. A database search yielded 19 RCTs including 6,450 patients, and 3,280 patients were allocated to the TXA group and 3,170 to the control group (placebo). Meta-analysis suggested that TXA did not influence the incidence of PO-AKI (4.2% v 4.3%; odds ratio [OR], 0.96; 95% CI, 0.75-1.22; p = 0.72). Meta-analysis also demonstrated that PO-SCr levels (weighted mean difference [WMD], 2.38; 95% CI, -2.80 to 7.56; p = 0.37) and PO-BUN levels (WMD, –0.16; 95% CI, –0.92 to 0.61; p = 0.69) were comparable between the TXA group and the control group, and that TXA did not influence PO-SCr and PO-BUN levels. Additionally, TXA did not influence the incidence of patients’ 30-day mortality postoperatively (1.1% v 1.6%; OR, 0.71; 95% CI, 0.46 to 1.09; p = 0.12).

This current study suggested that TXA administration did not influence renal outcomes in cardiovascular surgical patients.