Risks of harms using antifibrinolytics in cardiac surgery: systematic review and network meta-analysis of randomised and observational studies

摘要: Objective To estimate the relative risks of death, myocardial infarction, stroke, and renal failure or dysfunction between antifibrinolytics no treatment following suspension aprotinin from market in 2008 for safety reasons its recent reintroduction Europe Canada. Design Systematic review network meta-analysis. Data sources A Cochrane antifibrinolytic treatments was chosen as starting point this systematic review. Medline, Embase, register trials were searched with date restrictions observational evidence. Study selection Propensity matched adjusted studies two more interventions interest (aprotinin, tranexamic acid, epsilon-aminocaproic treatment) that carried out patients undergoing cardiac surgery. analysis Network meta-analysis used to compare treatments, odds ratios 95% credible intervals estimated. Meta-analyses randomised controlled alone studies. Results 106 11 (43 270 patients) included. Based on results trials, acid associated average a reduced risk death compared (odds ratio 0.64, interval 0.41 0.99). When data incorporated, comparisons showed an increased mortality 0.71, 0.50 0.98) (0.60, 0.43 0.87), all comparators: 0.66 (95% 0.45 0.88) treatment, (0.48 0.91) versus 0.65 (0.45 acid. Conclusion Although meta-analyses largely inconclusive, inclusion suggest concerns remain about aprotinin. Tranexamic are effective alternatives may be safer patients.