Antifibrinolytic drugs for acute traumatic injury.

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.

OBJECTIVES: To quantify the effect of antifibrinolytic drugs in reducing blood loss, transfusion requirement and mortality after acute traumatic injury.

SEARCH STRATEGY: We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE, Science Citation Index, National Research Register, Zetoc, SIGLE, Global Health, LILACS, and Current Controlled Trials.

SELECTION CRITERIA: We included all randomised controlled trials of antifibrinolytic agents (aprotinin, tranexamic acid [TXA] and epsilon-aminocaproic acid) following acute traumatic injury.

DATA COLLECTION AND ANALYSIS: The titles and abstracts identified in the electronic searches were screened by two independent reviewers 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 reviewers independently selected trials meeting the inclusion criteria, with any disagreements resolved by consensus.

MAIN RESULTS: Two studies met the inclusion criteria. The study by Auer (1979), with 20 randomised patients, provided no useable outcome data. The study by McMichan (1982), with 77 randomised patients, was reported in four separate reports. Outcome data were reported for death, the proportion undergoing surgical intervention and the volume of blood transfused. Because of the small number of randomised participants, the estimates for each of these outcomes were highly imprecise. Data on the proportion undergoing re-operation and the proportion receiving blood transfusion were not reported.

REVIEWERS' CONCLUSIONS: There is insufficient evidence from randomised controlled trials of antifibrinolytic agents in trauma to either support or refute a clinically important treatment effect. Further randomised controlled trials of antifibrinolytic agents in trauma are required.