Does the use of topical tranexamic acid in cardiac surgery reduce the incidence of post-operative mediastinal bleeding?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of topical tranexamic acid reduces the incidence of post-operative mediastinal bleeding. Altogether 511 papers were identified using the below mentioned search, of which only one paper presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the paper are tabulated. We conclude that, only 1 RCT exists to answer this question, which demonstrated a clinically small benefit in favour of topical tranexamic acid in low risk patients. Further RCTs should be performed prior to any further use of topical tranexamic acid as a strategy to reduce post-operative bleeding.