Antifibrinolytic drugs for acute traumatic injury

 

Abstract

Background

Uncontrolled bleeding is an important cause of death in trauma victims. Antifibrinolytic treatment has been shown to reduce blood loss following surgery and may also be effective in reducing blood loss following trauma.

Objectives

To quantify the effect of antifibrinolytic drugs in reducing blood loss, transfusion requirement and mortality after acute traumatic injury.

Search strategy

We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library issue 1, 2004), MEDLINE, PubMed, EMBASE, Science Citation Index, National Research Register, Zetoc, SIGLE, Global Health, LILACS, and Current Controlled Trials.

Selection criteria

We included all randomised controlled trials of antifibrinolytic agents (aprotinin, tranexamic acid [TXA] and epsilon-aminocaproic acid) following acute traumatic injury.

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

Two studies met the inclusion criteria. One involved 20 randomised patients, however, provided no useable outcome data. The other involved 77 randomised patients, and was reported in four separate papers. Outcome data were reported for death, the proportion undergoing surgical intervention and the volume of blood transfused. Because of the small number of randomised participants, the estimates for each of these outcomes were highly imprecise. Data on the proportion undergoing re-operation and the proportion receiving blood transfusion were not reported.

Authors' conclusions

There is insufficient evidence from randomised controlled trials of antifibrinolytic agents in trauma to either support or refute a clinically important treatment effect. Further randomised controlled trials of antifibrinolytic agents in trauma are required.

 

Plain language summary

Blood-clot promoting drugs for acute traumatic injury

Injury is the second leading cause of death for people aged five to 45 years. Over three million people worldwide die of injuries, usually because of extensive blood loss. Antifibrinolytic drugs promote blood clotting by preventing blood clots from breaking down. Some examples of antifibrinolytic drugs are aprotinin, tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA). Doctors sometimes give these drugs to patients having surgery to prevent blood loss. They appear to have few complications. These drugs might also stop blood loss in seriously injured patients and, as a result, save lives.

The review authors looked for research studies which compared injured patients who received antifibrinolytics with patients who did not. They sought randomised controlled trial, in which patients were randomly assigned to the treatment group (antifibrinolytics) or to the control group (receiving non-active or other treatment) as well as standard care. They found only two studies, with a total of 97 participants. These studies were very small and had inconclusive results.

There is currently no evidence that antifibrinolytic drugs can save the lives of injured patients through preventing blood loss. However, more research should be done because antifibrinolytics are a promising therapy and injury is a major killer worldwide.