title: Antifibrinolytic drugs for acute traumatic injury.
abstract: BACKGROUND
  Uncontrolled bleeding is an important cause of death in trauma victims. Antifibrinolytic treatment has been shown to reduce blood loss following surgery and may also be effective in reducing blood loss following trauma.
  
  
  OBJECTIVE
  To quantify the effects of antifibrinolytic drugs on mortality, vascular occlusive events, surgical intervention and receipt of blood transfusion after acute traumatic injury.
  
  
  METHODS
  We searched the PubMed, Science Citation Index, National Research Register, Zetoc, SIGLE, Global Health, LILACS, and Current Controlled Trials to March 2004 and the Cochrane Injuries Group Specialised Register, CENTRAL, MEDLINE and EMBASE to July 2010.
  
  
  METHODS
  We included all randomised controlled trials of antifibrinolytic agents (aprotinin, tranexamic acid [TXA] and epsilon-aminocaproic acid) following acute traumatic injury.
  
  
  METHODS
  The titles and abstracts identified in the electronic searches were screened by two independent authors to identify studies that had the potential to meet the inclusion criteria. The full reports of all such studies were obtained. From the results of the screened electronic searches, bibliographic searches, and contacts with experts, two authors independently selected trials meeting the inclusion criteria.
  
  
  RESULTS
  Four trials met the inclusion criteria, including 20,548 randomised patients. Two trials with a combined total of 20,451 patients assessed the effects of TXA on mortality; TXA reduced the risk of death by 10% (RR=0.90, 95% CI 0.85 to 0.97; P=0.0035). Data from one trial involving 20,211 patients found that TXA reduced the risk of death due to bleeding by 15% (RR=0.85, 95% CI 0.76 to 0.96; P=0.0077). There was evidence that early treatment (≤ 3 hours) was more effective than late treatment (>3 hours). There was no evidence that TXA increased the risk of vascular occlusive events or need for surgical intervention. There was no substantial difference in the receipt of blood transfusion between the TXA and placebo groups. The two trials of aprotinin provided no reliable data.
  
  
  CONCLUSIONS
  Tranexamic acid safely reduces mortality in bleeding trauma patients without increasing the risk of adverse events. TXA should be given as early as possible and within three hours of injury, as treatment later than this is unlikely to be effective. Further trials are needed to determine the effects of TXA in patients with isolated traumatic brain injury.
authors: Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. Ian.Roberts@Lshtm.ac.uk
authors: Ian
authors: I
authors: Roberts
authors: Haleema
authors: H
authors: Shakur
authors: Katherine
authors: K
authors: Ker
authors: Tim
authors: T
authors: Coats
mesh_terms: D015119:Aminocaproic Acid / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D007611:Aprotinin; D015119:Aminocaproic Acid