Antifibrinolytic drugs for acute traumatic injury

Abstract

The independent commentary was written by Valter Nilton Felix. DATA COLLECTION AND ANALYSIS:The titles and abstracts identified in the electronic searches were screened by two independent authors to identify studies that had the potential to meet the inclusion criteria.The full reports of all such studies were obtained. From the results of the screened electronic searches, bibliographic searches, and contacts with experts, two authors independently selected trials meeting the inclusion criteria, with any disagreements resolved by consensus. MAIN RESULTS: Four trials met the inclusion criteria. Two trials with a combined total of 20,451 patients assessed the effects of TXA on mortality; TXA reduced the risk of death by 10% (RR = 0.90, 95% CI 0.85 to 0.97; P = 0.0035). Data from one trial involving 20,211 patients found that TXA reduced the risk of death due to bleeding by 15% (RR = 0.85, 95% CI 0.76 to 0.96; P = 0.0077). There was no evidence that TXA increased the risk of vascular occlusive events or need for surgical intervention. There was no substantial difference in the receipt of blood transfusion between the TXA and placebo groups. The two trials of aprotinin provided no reliable data. AUTHORS' CONCLUSIONS: TXA safely reduces mortality in bleeding trauma patients without increasing the risk of adverse events. Further trials are needed to determine the effects of TXA in patients with isolated traumatic brain injury.

Aminocaproic acid use in hospitalized patients with hematological malignancy: a case series

“…Although the risk of thromboembolic events is an oftcited concern for antifibrinolytics, this complication has not been borne out by large meta-analyses in the surgical and trauma populations [29][30][31][32]. Similarly, an increased risk of thromboembolic events was not observed in our study or most other studies in patients with hematological malignancy.…”

Are Antifibrinolytic Agents Effective in the Treatment of Aneurysmal Subarachnoid Hemorrhage?

“…2 In fact, several recent studies have shown that these agents reduce morbidity and mortality in patients with various causes of acute surgical and nonsurgical bleeding. 3,4 Unfortunately, in the case of subarachnoid hemorrhage, the data summarized in this systematic review did not reveal improvements in either mortality…”

Effects of Tranexamic Acid on Mortality and Blood Transfusion in Trauma Patients with Significant Hemorrhage: A Clinical Trial

“…Based on CRASH-2 study, in a comprehensive review, Ker et al declare that using Tranxeamic acid in patients with traumarelated bleeding could decrease mortality and is recommended (28). A number of other studies also recommend use of Tranxemaic acid in trauma-related hemorrhage due to its potential effects in reducing mortality (6,29). However, our study did not reveal any decrease in mortality.…”

“…For instance, Aprotinin is an accepted drug for hemorrhage control in liver transplantation (4). However, use of antifibrinolytic agents in traumatic and traumarelated hemorrhagic shock is a novel strategy which could lessen mortality and morbidity (5,6). A number of studies recommend that Tranexamic acid can be used safely in trauma patients to control hemorrhage and reduce mortality (7)(8)(9)(10).…”