Meta-analysis of systemic anti-fibrinolytics in traumatic hyphaema

Abstract

SUMMARYWe report a meta-analysis of randomised, controlled, clinical trials of systemic anti-fibrinolytics in traumatic hyphaema . Outcome measures were rate of secondary haemorrhage and final visual acuity. An estimate of the overall odds ratio for each outcome measure was calcu lated both by combining the logarithms of the odds ratios, and by the Mantel-Haenszel method. The results confirm a beneficial effect of systemic antifibrinolytics on the rate of secondary haemorrhage, but not on final visual acuity.Traumatic hyphaema is a relatively common problem in Meta-analysis is a method of formal statistical analysis of data from several published trials, and may be con sidered to be a more rigorous alternative to narrative liter ature review. It has been widely applied in the social sciences, psychology and medicine, for example to resolve doubts about the role of intravenous streptokinase METHODSPublished trials of anti-fibrinolytic agents in the treatment of traumatic hyphaema were located by searching bio medical computer databases, recent review articles and reference lists of relevant reports. Only those trials which used a prospective, randomised, controlled study design were included in the analysis. Six such publications were found, in four of which the anti-fibrinolytic agent was aminocaproic acid9-1 2 and in two of which it was tranex amic acid. 1 3 , 1 4The following data were extracted from each trial report: The number of patients in both treatment and con trol groups with (1) secondary haemorrhage, (2) final visual acuity of 6/18 or worse, and (3) final visual acuity of 6/60 or worse. Figures for secondary haemorrhage were available in all six reports, but data on visual acuity were not given in one report. 1 3We carried out meta-analysis for the three separate sets of data described by constructing standard 2 x 2 tables, with columns for treated patients and controls, and rows for presence or absence of the outcome. Where zero entries were present for both treated and control groups Tables I to III give the raw data used in the 2 x 2 tables for the three outcome measures: rate of secondary haemor rhage, final visual acuity 6/18 or worse, and final visual acuity 6/60 or worse. RESULTSThe studies used in each meta-analysis and the results

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

“…Systemic antifibrinolytic agents have been used in the management of eye injuries where there is some evidence that they reduce the rate of secondary haemorrhage. 9 Need for a trial: A simple and widely practicable treatment that reduces blood loss following trauma might prevent thousands of premature trauma deaths each year and secondly could reduce exposure to the risks of blood transfusion. Blood is a scarce and expensive resource and major concerns remain about the risk of transfusion-transmitted infection.…”

Global Current Practice Patterns for the Management of Hyphema

“…Previous investigations thus far have shown management techniques to affect secondary hemorrhage rates, but not necessarily improve visual outcomes. 1,2,8,9,32 However, evidence-based management protocols are still needed to reduce clinical waste, limit unnecessary exposure to medication side effects or adverse surgical events, and ensure access to optimal care.…”

Antifibrinolytic Agents in Traumatic Haemorrhage

“…As a result, there is insufficient evidence to either support or refute a clinically important treatment effect. Systemic antifibrinolytic agents have been used in the management of eye injuries where there is some evidence that they reduce the rate of secondary haemorrhage [8]. …”