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Antifibrinolytic amino acids for acquired coagulation disorders in patients with liver disease

  • Review
  • Intervention

Authors


Abstract

Background

Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Patients with liver disease frequently have haemostatic abnormalities, which include hyperfibrinolysis. There are several primary treatments for upper gastrointestinal bleeding in patients with liver diseases. Supplementary interventions are used as well and antifibrinolytic amino acids are among them.

Objectives

To assess the beneficial and harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease and leading to acquired coagulation disorders.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (December 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 4, 2008), MEDLINE (1950 to December 2008), EMBASE (1980 to December 2008), Science Citation Index EXPANDED (1900 to December 2008), LILACS (1982 to January 2009), ClinicalTrials.gov (at www.clinicaltrials.gov) (accessed January 8, 2009), and the International Standard Randomised Controlled Trial Number Register (at http://controlled-trials.com/isrctn/search.asp) (accessed January 8, 2009). We also searched the Excelencia Clínica (January 8, 2009) and Sistema de Información Esencial en Terapéutica y Salud (January 9, 2009) clinical trials registers. We looked through the reference lists of the retrieved publications and review articles.

Selection criteria

Randomised clinical trials irrespective of blinding, language, or publication status.

Data collection and analysis

Data from randomised clinical trials were to be summarised by standard Cochrane Collaboration methodologies.

Main results

We could not find any randomised clinical trials with antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease plus acquired coagulation disorders.

Authors' conclusions

No randomised clinical trials assessing the safety and efficacy of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver disease (acute or chronic) plus acquired coagulation disorders were identified. The benefits and harms of antifibrinolytic amino acids need to be tested in randomised clinical trials. Unless randomised clinical trials provide evidence of a treatment effect and the trade off between potential benefits and harms are established, policy-makers, clinicians, and academics should be cautious when administering antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver diseases plus acquired disorders.

摘要

背景

抗纖維蛋白溶解氨基酸應用於後天凝血功能障礙肝病患者

上消化道出血是造成肝硬化病程中發病和死亡最常見的原因之一。肝病患者往往有凝血異常,其中包括過度纖維蛋白溶解(hyperfibrinolysis)。有幾種主要治療肝病患者上消化道出血的方法。也有包括抗纖維蛋白溶解氨基酸等補充治療被採使用。

目標

評估急性或慢性肝病導致的凝血功能障礙患者有上消化道出血時, 抗纖維蛋白溶解氨基酸的益處和害處。

搜尋策略

我們搜索了 Cochrane HepatoBiliary Group Controlled Trials Register(2008年12月)、Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL) (第4期,2008期)、MEDLINE(1950年至2008年12月)、EMBASE(1980年至12月2008年)、Science Citation Index EXPANDED(SCI)(1900年至2008年12月)、LILACS(1982年至2009年1月),ClinicalTrials.gov(www.clinicaltrials.gov)(2009年1月8日)和 International Standard Randomised Controlled Trial Number Register(http://controlledtrials.com/isrctn/search.asp)(2009年1月8日)。我們還搜尋Excelencia Clinica(2009年1月8日)和Sistema de Informacion Esencial en Terapeutica y Salud(2009年1月9日)clinical trials registers。我們徹底檢視所得發表文章與回顧的參考文獻表。

選擇標準

隨機分配臨床試驗,不限盲法採用、語言或發表型態。

資料收集與分析

數據擷自隨機臨床試驗的數據以標準 Cochrane Collaboration方法學歸納結論。

主要結論

無法找到任何有關急性或慢性肝病導致後天凝血功能障礙患者併發上消化道出血時使用抗纖維蛋白溶解氨基酸的隨機臨床試驗。

作者結論

沒有評量急性或慢性肝病導致後天凝血功能障礙患者併發上消化道出血時,抗纖維蛋白溶解氨基酸安全性和療效的隨機臨床試驗。抗纖維蛋白溶解氨基酸的利弊需要隨機臨床試驗的檢測。除非有隨機臨床試驗提供其治療效果的證據與潛在利弊之間的權衡確立,否則決策者、臨床醫師和學者應謹慎使用抗纖維蛋白溶解氨基酸來治療急性或慢性肝病導致凝血功能障礙患者的上消化道出血.

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有隨機臨床試驗評價急性或慢性肝病導致後天凝血功能障礙患者併發上消化道出血時, 抗纖維蛋白溶解氨基酸的益處和壞處:上消化道出血是一種肝硬化病程中最常致病與致病的原因。肝病患者往往有凝血異常,其中包括過度纖維蛋白溶解。抗纖維蛋白溶解氨基酸可用於治療這種腸胃道急症。但目前還不清楚是否有利於或有害於肝病導致後天凝血功能障礙患者合併上消化道出血。這次更新回顧沒有發現隨機臨床試驗可證明肝病患者併發上消化道出血時, 抗纖維蛋白溶解氨基酸的安全性和療效

Plain language summary

There is no evidence from randomised clinical trials to establish the beneficial or harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver disease plus acquired coagulation disorders

Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Patients with liver disease frequently have haemostatic abnormalities, which include hyperfibrinolysis. Antifibrinolytic amino acids could be used to treat this gastrointestinal emergency. But, it is unknown whether it benefits or harms patients with liver disease plus acquired coagulation disorders and upper gastrointestinal bleeding. This updated review found no randomised clinical trials on the safety and efficacy of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver diseases.

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