title: Pharmacological adjuncts to stop bleeding: options and effectiveness.
abstract: Severe trauma and massive haemorrhage represent the leading cause of death and disability in patients under the age of 45 years in the developed world. Even though much advancement has been made in our understanding of the pathophysiology and management of trauma, outcomes from massive haemorrhage remain poor. This can be partially explained by the development of coagulopathy, acidosis and hypothermia, a pathological process collectively known as the "lethal triad" of trauma. A number of pharmacological adjuncts have been utilised to stop bleeding, with a wide variation in the safety and efficacy profiles. Antifibrinolytic agents in particular, act by inhibiting the conversion of plasminogen to plasmin, therefore decreasing the degree of fibrinolysis. Tranexamic acid, the most commonly used antifibrinolytic agent, has been successfully incorporated into most trauma management protocols effectively reducing mortality and morbidity following trauma. In this review, we discuss the current literature with regard to the management of haemorrhage following trauma, with a special reference to the use of pharmacological adjuncts. Novel insights, concepts and treatment modalities are also discussed.
authors.affiliation: Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Level A, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK. michalispanteli@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Panteli
authors.affiliation: Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Level A, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK.
authors.forename: I
authors.initials: I
authors.lastname: Pountos
authors.affiliation: Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Level A, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK.|NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000628:therapy*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion / Q000379:methods*; D002985:Clinical Protocols; D005342:Fibrinolysis; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000628:therapy*; D009104:Multiple Trauma / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Antifibrinolytics; Bleeding; Coagulopathy; Haemostasis; Tranexamic acid; Trauma