Effect of tranexamic acid by baseline risk of death in acute bleeding patients: a meta-analysis of individual patient-level data from 28 333 patients.

Détails

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Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_B2B62208D836
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Effect of tranexamic acid by baseline risk of death in acute bleeding patients: a meta-analysis of individual patient-level data from 28 333 patients.
Périodique
British journal of anaesthesia
Auteur(s)
Ageron F.X., Gayet-Ageron A., Ker K., Coats T.J., Shakur-Still H., Roberts I.
Collaborateur(s)
Antifibrinolytics Trials Collaboration
Contributeur(s)
Kayani A., Geer A., Ndungu B., Fawole B., Gilliam C., Adetayo C., Barrow C., Beaumont D., Prowse D., I'Anson D., Balogun E., Miah H., Shakur-Still H., Roberts I., Brooks I., Onandia J., Ker K., Javaid K., Suncuan L., Frimley L., Reid M., Arribas M., Benyahia M., Okunade O., Edwards P., Chaudhri R., Kostrov S., Kansagra S., Pepple T.
ISSN
1471-6771 (Electronic)
ISSN-L
0007-0912
Statut éditorial
Publié
Date de publication
06/2020
Peer-reviewed
Oui
Volume
124
Numéro
6
Pages
676-683
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis
Publication Status: ppublish
Résumé
Early administration of the antifibrinolytic drug tranexamic acid reduces death from bleeding in trauma and postpartum haemorrhage. We examined how the effectiveness and safety of antifibrinolytic drugs varies by the baseline risk of death as a result of bleeding.
We performed an individual patient-level data meta-analysis of randomised trials including more than 1000 patients that assessed antifibrinolytics in acute severe bleeding. We identified trials performed between January 1, 1946 and July 5, 2018 (PROSPERO, number 42016052155).
Two randomised trials were selected where 28 333 patients received tranexamic acid treatment within 3 h after the onset of acute bleeding. Baseline characteristics to estimate the risk of death as a result of bleeding were divided into four categories: Low (0-5%), intermediate (6-10%), high (11-20%), and very high (>20%). Most patients had a low baseline risk of death as a result of bleeding (23 008 [81%]). Deaths as a result of bleeding occurred in all baseline risk categories with 240 (1%), 202 (8%), 232 (14%), and 357 (30%) deaths in the low-, intermediate-, high-, and very high-risk categories, respectively. The effectiveness of tranexamic acid did not vary by baseline risk when given within 3 h after bleeding onset (P=0.51 for interaction term). There was no increased risk of vascular occlusive events with tranexamic acid and it did not vary by baseline risk categories (P=0.25).
Tranexamic acid appears to be safe and effective regardless of baseline risk of death. Because many deaths are in patients at low and intermediate risk, tranexamic acid use should not be restricted to the most severely injured or bleeding patients.
Mots-clé
Acute Disease, Adult, Antifibrinolytic Agents/therapeutic use, Female, Hemorrhage/drug therapy, Humans, Male, Randomized Controlled Trials as Topic, Risk, Tranexamic Acid/therapeutic use, Young Adult, antifibrinolytics, bleeding, coagulopathy, mortality, postpartum haemorrhage, trauma
Pubmed
Web of science
Open Access
Oui
Création de la notice
01/04/2020 19:21
Dernière modification de la notice
30/04/2021 6:14
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