Traumatic injury.
Article Type: Clinical report
Subject: Antifibrinolytic agents (Usage)
Antifibrinolytic agents (Health aspects)
Hemorrhage (Care and treatment)
Hemorrhage (Patient outcomes)
Brain (Injuries)
Brain (Care and treatment)
Brain (Patient outcomes)
Author: Marsland, Scott
Pub Date: 03/22/2011
Publication: Name: Journal of the New York State Nurses Association Publisher: New York State Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New York State Nurses Association ISSN: 0028-7644
Issue: Date: Spring-Winter, 2011 Source Volume: 42 Source Issue: 1-2
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 278760670
Full Text: Roberts, I., Shakur, H., Ker, K., & Coats, T., on behalf of the CRASH-2 Trial collaborators. (2011). Antifibrinolytic drugs for acute traumatic injury. Cochrane Database of Systematic Reviews, 1. DOI: 10.1002/14651858.CD004896.pub3

Every year trauma accounts for 1 in 10 deaths worldwide. Bleeding, directly or indirectly, causes 39% of these deaths. Complicating this issue is the global shortage of safe blood for transfusions. Antifibrinolytic agents are used in patients undergoing major surgery in order to prevent fibrinolysis and minimize blood loss. New evidence shows that the use of antifibrinolytics in patients with traumatic bleeding offers a quick, inexpensive intervention to save lives from hemorrhage and conserve precious blood products.

An updated Cochrane review from November 201 1 addresses the effects of antifibrinolytic agents on mortality and transfusion requirements in trauma patients with significant hemorrhage. Twelve electronic databases including PubMed and Medline were searched from 1966 to the present. All four studies in this review were randomized controlled trials. The purpose of the review was to examine the effects of antifibrinolytic drugs in trauma patients with bleeding or risk for bleeding. The primary outcome was mortality, and secondary outcomes were adverse events, unexpected surgical intervention, blood transfusions, and volume of blood transfused.

The reviewers concluded that the antifibrinolytic drug, tranexamic acid (TXA), reduces all-cause mortality in bleeding trauma patients. There was no apparent increase in the risk of vascular occlusive events or in the risk of receiving one or more surgical interventions. TXA administration was not associated with a reduction in either number of blood transfusions or volume of blood transfused. The CRASH-2 study authors suggest that these findings could relate either to decisions to transfuse made early in the patients' treatment or to the fact that reduced mortality in the intervention group led to increased stays during which transfusions could be given. Statistical evidence demonstrated reduction in mortality from hemorrhage by about one-sixth.

Future research should explore how TXA may also be used in other scenarios where bleeding is life threatening or disabling and what effects it may have on disability in patients with isolated traumatic brain injury.

Based on this evidence, the British military has started saving wounded soldiers with TXA in Afghanistan, and civilian trauma centers globally are adopting TXA protocols.

Scott Marsland, SUNY Upstate Medical University, Syracuse, NY
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.

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