Antifibrinolytic Drugs for Acute Traumatic Injury
The Article: Antifibrinolytic drugs for acute traumatic injury (Review).
Ker K, Roberts I, Shakur H, Coats TJ. Cochrane Database of Systematic Reviews. 2015, Issue 5. Art. No.:CD004896. DOI: 10.1002/14651858.pub4.
The Idea: Injury is the second leading cause of death for people aged five to 45 years and millions of people die of injuries, most often because of extensive blood loss. Antifibrinolytics promote blood clotting by preventing clots from breaking down. The purpose of the article was to perform a review of the literature in order to determine whether antifibrinolytic treatment is shown to reduce blood loss following trauma.
The Study: The authors screened electronic searches, bibliographic searches, and contacted experts to determine inclusion criteria and to extract data from the literature. Articles selected for review included randomized controlled trials of antifibrinolytic agents (aprotinin, TXA, etc.) used for acute traumatic injury. Outcomes measured included all-cause mortality at end of follow-up, adverse events (VOE’s – MI, DVT, PE, etc.), surgical interventions, blood transfusions, volume of blood transfused, volume of intracranial bleeding, death, and disability. Three studies met inclusion criteria, two of which assessed effects of TXA, and one of aprotinin. The majority of the data was contributed by the 2010 CRASH-2 study of TXA.
The Findings: Antifibrinolytic drugs reduce the risk of death from any cause by 10%. There is no evidence that antifibrinolytics have an effect on the risk of vascular occlusive events, need for surgical intervention, or receipt of blood transfusion; however, patients receiving an antifibrinolytic received less transfused blood. The pooled analyses were based primarily on TXA and the effects of aprotinin remain uncertain. In patients with TBI, uncertainty remains on whether TXA may reduce mortality; however, it may reduce intracranial bleeding.
The Takeaway: TXA safely reduces mortality in trauma patients with bleeding without increasing the risk of adverse events. TXA should be given as early as possible and within three hours of injury, as delayed treatment is unlikely effective and may be harmful. Further investigation is required as to whether TXA is beneficial in patients with TBI.