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Anti-Fibrinolytic Agents In Traumatic Haemorrhage

Author(s): Lan ROBERTS | Tim COATS | Hunt BEVERLY | Shakur HALEEMA

Journal: Journal of Neurological Sciences
ISSN 1300-1817

Volume: 22;
Issue: 02;
Start page: 231;
Date: 2005;
Original page

Keywords: Traumatic hemorrhage | anti-fibrinolytic agents | aprotinin | tranexamic acid

--------------------------------------------------------------------------------For people at ages 5 to 45 years, trauma is second only to HIV/AIDS as a cause of death. Each year, worldwide, over three million people die as a result of trauma, many after reaching hospital. Among trauma patients who do survive to reach hospital, exsanguination is a common cause of death, accounting for nearly half of in-hospital trauma deaths. Central nervous system injury and multi-organ failure account for most of the remainder, both of which can be exacerbated by severe bleeding. Systemic anti-fibrinolytic agents are widely used in major surgery to prevent fibrinolysis and thus reduce surgical blood loss. A recent systematic review6 of randomised controlled trials of anti-fibrinolytic agents (mainly aprotinin or tranexamic acid) in elective surgical patients identified 89 trials including 8,580 randomised patients (74 trials in cardiac, eight in orthopaedic, four in liver, and three in vascular surgery). The results showed that these treatments reduced the numbers needing transfusion by one third, reduced the volume needed per transfusion by one unit, and halved the need for further surgery to control bleeding. These differences were all highly statistically significant. There was also a statistically non-significant reduction in the risk of death (RR=0.85: 95%CI 0.63 to 1.14) in the anti-fibrinolytic treated group. The CRASH 2 trial will be a large international, placebo controlled trial of the effects of the early administration of the anti-fibrinolytic agent tranexamic acid on death, vascular events and transfusion requirements.
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