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Tranexamic acid looks promising during emergency surgery

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f697 (Published 06 February 2013) Cite this as: BMJ 2013;346:f697

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Tranexamic acid is an antifibrinolytic agent that helps control bleeding in trauma patients and in those scheduled for high risk elective surgery. Tranexamic acid can also be useful during emergency surgery, according to a new systematic review. The authors found only five small trials, but in pooled analyses adults given tranexamic acid just before or during emergency surgery were 30% less likely to need a blood transfusion than controls, most of whom were given saline instead (relative risk 0.7, 95% CI 0.52 to 0.94).

Most participants were having surgery for broken femurs or hips. One trial tested tranexamic acid in adults having emergency coronary artery bypass surgery. Pooled analyses comprised three trials and a total of 260 participants. The authors weren’t able to tell whether tranexamic acid saved lives or caused extra thromboembolic events or strokes. The trials took place in Iran, Turkey, France, and India. Two were reported only as abstracts, and attempts to obtain full reports failed.

We know that this agent reduces mortality in trauma patients who are bleeding, thanks to a large randomised trial called CRASH-2, say the authors. Half of those participants needed surgery, so an effect on mortality in broader populations of patients having emergency surgery looks possible, and even likely. At least one large pragmatic trial should be done, to fill an important gap in the evidence.

Notes

Cite this as: BMJ 2013;346:f697