Adjunct agents for bleeding

Franchini, Massimo; Mannucci, Pier Mannuccio

doi:10.1097/moh.0000000000000084

Cited by 14 publications

(11 citation statements)

References 37 publications

(28 reference statements)

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“…The efficacy of another serine protease inhibitor, nafamostat mesilate, was evaluated in 22 patients who underwent hepatic resection for hepatocellular carcinoma: despite laboratory evidence of control of hyperfibrinolysis, blood loss was not different in the treated and control groups [160]. Epsilon aminocaproic acid interferes with plasminogen binding to fibrin, thus inhibiting the conversion of plasminogen to plasmin [161]. Similarly, tranexamic acid inhibits fibrinolysis by competitively inhibiting plasminogen at 6-10-fold higher potency than epsilon aminocaproic acid [162].…”

Section: Antifibrinolyticsmentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Section: Antifibrinolyticsmentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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“…There are two available anti-fibrinolytics that block the lysine binding site on plasminogen preventing its attachment to fibrin and subsequent activation: trans-p-aminomethyl-cyclohexane carboxylic acid or tranexamic acid and epsilon-aminocaproic acid (EACA). 118 119 Both agents can be given orally or intravenously. Neither are felt to be significantly pro-thrombotic based on studies in cardiac surgery of EACA versus placebo.…”

Section: Introductionmentioning

confidence: 99%

Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference

et al. 2018

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Percutaneous biopsy of extra-hepatic organ or lesions Cardiac catheterization Trans-arterial or percutaneous HCC therapies Central line placement Abbreviations: HCC, hepatocellular cancer; NOTES, natural orifice transluminal endoscopy. a Risk is estimated here based on relative vascularity, degree of expected vascular breech and potential clinical consequences, but risk should always be defined by clinician preforming the procedure.

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“…These medications target plasmin, the protease responsible for fibrinolysis, that is, proteolysis of fibrin destroying fibrin clots and excessive hemorrhage. Among antifibrinolytic medications are the small protein aprotinin, and the lysine analogs TXA and epsilon‐aminocaproic acid (EACA) 1 . After the BART trial, aprotinin was withdrawn from the market in the United States because of an association with acute kidney injury 2 .…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid: Beyond antifibrinolysis

et al. 2022

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Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. A number of studies have demonstrated the broad life‐saving effects of TXA in trauma, superior to those of other antifibrinolytic agents. Besides preventing fibrinolysis and blood loss, TXA has been reported to suppress posttraumatic inflammation and edema. Although the efficiency of TXA transcends simple inhibition of fibrinolysis, little is known about its mechanisms of action besides the suppression of plasmin maturation. Understanding the broader effects of TXA at the cell, organ, and organism levels are required to elucidate its potential mechanisms of action transcending antifibrinolytic activity. In this article, we provide a brief review of the current clinical use of TXA and then focus on the effects of TXA beyond antifibrinolytics such as its anti‐inflammatory activity, protection of the endothelial and epithelial monolayers, stimulation of mitochondrial respiration, and suppression of melanogenesis.

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Adjunct agents for bleeding

Abstract: Although preliminary data document a potential therapeutic role for prohemostatic pharmacologic approaches, further evidence arising from randomized controlled trials is needed to assess the safety and efficacy of such agents in the setting of critical bleeding.

Cited by 14 publications

References 37 publications

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference

Tranexamic acid: Beyond antifibrinolysis

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