Anti-fibrinolytic agents in post partum haemorrhage: a systematic review

Ferrer, Pili; Roberts, Ian; Sydenham, Emma; Blackhall, Karen; Shakur, Haleema

doi:10.1186/1471-2393-9-29

Cited by 114 publications

(89 citation statements)

References 14 publications

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“…A recent meta-analysis on TXA in pregnancy and postpartum [118] by Peisidis et al [118] included several quasi-blinded trials [119−121] excluded from the above Cochrane review, and found a combined estimated decrease of blood loss by 32.5 mL in TXA pre-caesarean section vs a control. A similar effect of TXA was found in a separate meta-analysis by Ferrer et al [122] in a reduction of postpartum blood loss by 92 mL compared with the control.…”

Section: Obstetric and Gynecologysupporting

confidence: 60%

Tranexamic acid: a clinical review

Jerath

Wąsowicz

2015

Anaesthesiol Intensive Ther

253

151

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Blood loss and subsequent transfusions are associated with major morbidity and mortality. The use of antifibrinolytics can reduce blood loss in cardiac surgery, trauma, orthopedic surgery, liver surgery and solid organ transplantation, obstetrics and gynecology, neurosurgery and non-surgical diseases. The evidence of their efficacy has been mounting for years. Tranexamic acid (TXA), a synthetic lysine-analogue antifibrinolytic, was first patented in 1957 and its use has been increasing in contrast to aprotinin, a serine protease inhibitor antifibrinolytic. This review aims to help acute care physicians navigate through the clinical evidence available for TXA therapy, develop appropriate dose regimens whilst minimizing harm, as well as understand its broadening scope of applications. Many questions remain unanswered regarding other clinical effects of TXA such as anti-inflammatory response to cardiopulmonary bypass, the risk of thromboembolic events, adverse neurological effects such as seizures, and its morbidity and mortality, all of which necessitate further clinical trials on its usage and safety in various clinical settings.

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Section: Obstetric and Gynecologysupporting

confidence: 60%

Tranexamic acid: a clinical review

Jerath

Wąsowicz

2015

Anaesthesiol Intensive Ther

253

151

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“…53 Although evidence suggests that this drug reduces postpartum bleeding, the quality of the existing trials is poor and none have been large enough to assess the effect of TXA on end points that are important to women. 54 A large trial is currently under way to assess the effect of TXA on the risk of death and hysterectomy in women with postpartum haemorrhage.…”

Section: Future Clinical Researchmentioning

confidence: 99%

The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients

Roberts

Shakur²,

Coats³

et al. 2013

Health Technol Assess

571

399

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Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Clinical Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 06/303/20. The contractual start date was in April 2007. The draft report began editorial review in January 2012 and was accepted for publication in August 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Background: Among trauma patients who survive to reach hospital, exsanguination is a common cause of death. A widely practicable treatment that reduces blood loss after trauma could prevent thousands of premature deaths each year. The CRASH-2 trial aimed to determine the effect of the early administration of tranexamic acid on death and transfusion requirement in bleeding trauma patients. In addition, the effort of tranexamic acid on the risk of vascular occlusive events was assessed.

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“…Sekhavat, et al [22] in their study used TXA immediately before CS in pregnant women and showed that bleeding was reduced until two hours after CS and the Hb levels at 24 hours after surgery were higher than control group [22]. Ferrer, et al [23] in their systematic review of using TXA to control PPH concluded TXA may reduce bleeding after delivery, but further studies are needed to prove this effect [23]. The present study as the above studies achieved to the positive results about the effects of TXA to decrease PPH and puerperal bleeding.…”

Section: Discussionmentioning

confidence: 99%