Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.06.003
Brazilian Journal of Anesthesiology
Review Article

Efficacy and safety of antifibrinolytics in oncological surgery: a systematic review and meta‐analysis

Eficácia e segurança de antifibrinolíticos em cirurgia oncológica: uma revisão sistemática e metanálise

Aline Menezes Sampaio, Gabriel Magalhães Nunes Guimarães, Germano Pinheiro Medeiros, Germana Medeiros Mendes Damasceno, Ricardo Martins de Abreu Silva, Rogean Rodrigues Nunes, Hermano Alexandre Lima Rocha, José Carlos Rodrigues Nascimento

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Abstract

Background and objectives
The administration of antifibrinolytics has been shown to be effective in reducing blood loss and the need for transfusions in surgeries. However, few studies have evaluated these drugs in cancer surgery. The objective was to review the efficacy and safety of the treatment with antifibrinolytics in patients who underwent oncologic surgeries.

Contents
An electronic bibliographic research was conducted in PubMed, OVID, MEDLINE, EMBASE, EBSCO and in the Cochrane Library data basis in order to identify randomized clinical trials performed in any type of oncologic surgery. The data evaluated were blood loss, need for transfusion and incidence of arteriovenous thromboembolism. Five randomized controlled trials evaluating 838 patients met the inclusion requirements. In the analysis of the incidence of thromboembolic events in the five RCTs, there was no statistically significant difference between the administration of tranexamic acid when compared with the placebo (OR = 0.36, 95% IC: 0.11–1.19, p = 0.09, I2 = 0%). However, when total estimated blood loss and need for blood transfusion are analyzed, the use of tranexamic acid was associated with a significant reduction over placebo (MD = ‐135.79, 95% CI: ‐179.50 to ‐92.08, p < 0.00001, I2 = 68%) and (OR = 0.45, 95% CI: 0.32–0.65, p < 0.00001, I2 = 60%), respectively.

Conclusions
This meta‐analysis found no evidence that the administration of antifibrinolytics increases the risk of thromboembolic complications in patients submitted to oncologic surgery, and has shown evidence that it is effective in reducing total perioperative blood loss and the need for blood transfusion.

Keywords

Antifibrinolytic agents; Cancer surgery; Thromboembolism; Blood loss

Resumo

Justificativa e objetivos
A administração de agentes antifibrinolíticos mostrou ser eficaz para reduzir a perda sanguínea e a necessidade de transfusões em cirurgias. No entanto, poucos estudos avaliaram esses agentes em cirurgias oncológicas. O objetivo foi revisar a eficácia e segurança do tratamento com antifibrinolíticos em pacientes submetidos a cirurgias oncológicas.

Conteúdo
Uma pesquisa bibliográfica foi conduzida nos bancos de dados eletrônicos PubMed, Ovid, Medline, Embase, Ebsco e na Biblioteca Cochrane para identificar estudos clínicos randômicos feitos em qualquer tipo de cirurgia oncológica. Os dados analisados foram perda sanguínea, necessidade de transfusão e incidência de tromboembolismo arteriovenoso. Cinco ensaios clínicos randômicos que avaliaram 838 pacientes atenderam aos critérios de inclusão. Na análise da incidência de eventos tromboembólicos em cinco ECR, não houve diferença estatisticamente significativa entre a administração do ácido tranexâmico, comparado ao placebo (OR = 0,36, IC 95%: 0,11‐1,19, p = 0,09; I2 = 0%). No entanto, quando a perda sanguínea total estimada e a necessidade de transfusão de sangue foram analisadas, o uso do ácido tranexâmico foi associado a uma redução significativa, comparado ao placebo. (DM: ‐135,79, IC 95%: ‐179,50 a ‐92,08, p < 0,00001, I2 = 68%) e (OR = 0,45, IC 95%: 0,32‐0,65, p < 0,00001, I2 = 60%), respectivamente.

Conclusões
Esta metanálise não encontrou evidências de que a administração de antifibrinolíticos aumente o risco de complicações tromboembólicas em pacientes submetidos à cirurgia oncológica e apresentou evidências de que é eficaz para reduzir a perda sanguínea total no perioperatório e a necessidade de transfusão de sangue.

Palavras-chave

Agentes antifibrinolíticos; Cirurgia oncológica; Tromboembolismo; Perda sanguínea

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