Tranexamic acid for reducing mortality in emergency and urgent surgery.

نویسندگان

  • Pablo Perel
  • Katharine Ker
  • Carlos Hernando Morales Uribe
  • Ian Roberts
چکیده

BACKGROUND Emergency or urgent surgery, which can be defined as surgery which must be done promptly to save life, limb, or functional capacity, is associated with a high risk of bleeding and death. Antifibrinolytic agents, such as tranexamic acid, inhibit blood clot breakdown (fibrinolysis) and can reduce perioperative bleeding. Tranexamic acid has been shown to reduce the need for a blood transfusion in adult patients undergoing elective surgery but its effects in patients undergoing emergency or urgent surgery is unclear.   OBJECTIVES To assess the effects of tranexamic acid on mortality, blood transfusion and thromboembolic events in adults undergoing emergency or urgent surgery. SEARCH METHODS We searched the following electronic databases: the Cochrane Injuries Group's Specialised Register (22 August 2012); Cochrane Central Register of Controlled Trials (2012, issue 8 of 12); MEDLINE (Ovid SP) 1950 to August Week 2, 2012; PubMed 1 June 2012 to 22 August 2012; EMBASE (Ovid SP) 1980 to 2012 Week 33; ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) 1990 to 22 August 2012; ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) 1970 to 22 August 2012. We also searched online trial registers on 22 August 2012 to identify unpublished studies. SELECTION CRITERIA Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in adults undergoing emergency or urgent surgery. DATA COLLECTION AND ANALYSIS Two authors examined titles, abstracts and keywords of citations from the electronic databases for eligibility and extracted data for analysis and risk of bias assessment. Outcome measures of interest were mortality, receipt of a blood transfusion, units of blood transfused, reoperation, seizures and thromboembolic events (myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism). MAIN RESULTS We identified five trials involving 372 people that met the inclusion criteria. Three trials (260 patients) contributed data to the analyses. The effect of tranexamic acid on mortality (RR 1.01; 95% CI 0.14 to 7.3) is uncertain. However, tranexamic acid reduces the probability of receiving a blood transfusion by 30% although the estimate is imprecise (RR 0.70; 95% CI 0.52 to 0.94). The effect on deep venous thrombosis (RR 2.29; 95% CI 0.68 to 7.66), and stroke (RR 2.79; 95% CI 0.12 to 67.10) is uncertain. There were no events of pulmonary embolism or myocardial infarction. None of the trials reported units of blood transfused, reoperation, or seizure outcomes. AUTHORS' CONCLUSIONS There is evidence that tranexamic acid reduces blood transfusion in patients undergoing emergency or urgent surgery. There is a need for a large pragmatic clinical trial to assess the effects of routine use of tranexamic acid on mortality in a heterogeneous group of urgent and emergency surgical patients.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

The Effect of Topical Tranexamic Acid on Bleeding Reduction during Functional Endoscopic Sinus Surgery

Introduction:Bleeding is a common concern during functional endoscopic sinus surgery (FESS) that can increase the risk of damage to adjacent vital elements by reducing the surgeon’s field of view. This study aimed to explore the efficacy of topical tranexamic acid in reducing intraoperative bleeding. Materials and Methods:This double-blind, randomized clinical trial was conducted in 60 patients...

متن کامل

Tranexamic Acid in Total Joint Arthroplasty: Efficacy and Safety

  Despite improvements in surgical and anesthetic techniques, total joint arthroplasty (TJA) is still associated with substantial blood loss and postoperative anemia (1). A considerable portion of patients with postoperative anemia require blood transfusion, which has been shown to negatively affect the outcome of TJA and predisposes patients to development of surgical site infection and peripr...

متن کامل

Role of Tranexamic Acid in Treatment of Patients with Epidural Hematoma

Introduction: Traumatic brain injury is considered as the major cause of mortality and hospitalization of about ten million people across the globe. Most of these patients are young and active people suffering disabilities. Tranexamic acid therapy is commonly used to reduce blood loss and need for blood transfusions in surgical cases. This study aimed at investigating the effect of tr...

متن کامل

Comparative Study of the Efficacy of Topical Tranexamic Acid with Nasal Tampon in Management of Epistaxis: A Randomized Clinical Trial

Background and Aim: Epistaxis is one of the most common symptoms referring to emergency department, which suitable and effective treatment needs in short term. Therefore the purpose of the present study was to compare the outcome of topical tranexamic acid (TA) with nasal tampon in management of epistaxis. Materials and Methods: The present clinical trial study was performed on 150 patients wit...

متن کامل

Evaluation of Topical Tranexamic Acid on Intraoperative Bleeding in Endoscopic Sinus Surgery

Tranexamic acid (TA) is an antifibrinolytic agent which reduces bleeding following certain surgical procedures. The present study was performed on 56 patients, scheduled for elective endoscopic sinus surgery under general anesthesia, to examine the effects of topical TA on providing a bloodless surgical field and evaluate the bleeding volume. The study comprised 26 patients who received topical...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • The Cochrane database of systematic reviews

دوره 1  شماره 

صفحات  -

تاریخ انتشار 2013