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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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
British Journal of Anaesthesia, Volume 124, No. 6, Year 2020
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Description
Background: 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. Methods: 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). Results: 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). Conclusions: 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. © 2020 The Author(s)
Authors & Co-Authors
Ageron, François Xavier
United Kingdom, London
London School of Hygiene & Tropical Medicine
Switzerland, Lausanne
Centre Hospitalier Universitaire Vaudois
Gayet-Ageron, Angèle
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Ker, Katharine
United Kingdom, London
London School of Hygiene & Tropical Medicine
Coats, Timothy J.
United Kingdom, Leicester
University of Leicester
Shakur-Still, Haleema
United Kingdom, London
London School of Hygiene & Tropical Medicine
Roberts, Ian G.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Kayani, Aasia
Unknown Affiliation
Geer, Amber
Unknown Affiliation
Ndungu, Bernard
Unknown Affiliation
Fawole, Bukola O.
Unknown Affiliation
Gilliam, Catherine
Unknown Affiliation
Adetayo, Cecilia Olusade
Unknown Affiliation
Barrow, Collette
Unknown Affiliation
Beaumont, Danielle D.
Unknown Affiliation
Prowse, Danielle
Unknown Affiliation
I'Anson, David
Unknown Affiliation
Balogun, Eni
Unknown Affiliation
Miah, Hakim
Unknown Affiliation
Brooks, Imogen
Unknown Affiliation
Gil Onandia, Julio
Unknown Affiliation
Javaid, Kiran
Unknown Affiliation
Frimley, Lauren
Unknown Affiliation
Reid, Mia
Unknown Affiliation
Arribas, Monica
Unknown Affiliation
Benyahia, Myriam
Unknown Affiliation
Okunade, Olujide A.
Unknown Affiliation
Edwards, Phil James
Unknown Affiliation
Chaudhri, Rizwana
Unknown Affiliation
Kostrov, Sergey
Unknown Affiliation
Kansagra, Sneha
Unknown Affiliation
Pepple, Tracey
Unknown Affiliation
Statistics
Citations: 22
Authors: 31
Affiliations: 4
Identifiers
Doi:
10.1016/j.bja.2020.01.020
ISSN:
00070912
Research Areas
Health System And Policy
Maternal And Child Health
Study Approach
Systematic review