1/20/16 – Antifibrinolytic Drugs for Acute Traumatic Injury

Katharine Ker, Ian Roberts, Haleema Shakur, Tim J Coats

The usefulness of antifibrinolytics in reducing adverse outcomes due to hemorrhage in surgical patients having been quite well established, this paper aimed to assess their effect in patients suffering acute trauma by a review of relevant randomized controlled trials. This is an update to a 2004 review paper (last reviewed in 2012) with data now current up to Jan 2015.  Outcomes considered were mortality (primary) and adverse events such as MI, DVT, PE, surgery and receipt of blood transfusion (secondary).

Very satisfactory methods of study selection, data extraction, and risk of bias assessment were employed allowing for greater confidence in the authors’ findings.

One trial on Aprotinin (1982) and two trials on Tranexamic acid (2010 and 2013) were included. The Aprotinin trial included 77 patients, one TXA study had 240 traumatic brain injury patients, the other 20,211 trauma patients from 274 hospitals in 40 countries. The quality of evidence from the TXA trials were considered very high, that from the Aprotinin trial moderate. Most results were based on data from the TXA studies. Since Aprotinin has fallen into disuse in many centers, it seems reasonable to focus less on findings related to this antifibrinolytic.

Risk of each adverse outcome computed was equivalent or reduced with antifibrinolytic use compared to placebo. A minimal but significant reduction in amount of blood transfused was seen in patients with use of antifibrinolytics.

The authors concluded that TXA safely reduces mortality in bleeding trauma patients when given within three hours of injury. They also recognize the implications that such a conclusion can have for other situations where life-threatening bleeding occurs, and the need for further research.

It will be interesting to see more studies evaluating treatment procedures in trauma scenarios, with the intention of improving outcomes while also improving blood management.