Universität zu Köln

Lier, Heiko ORCID: 0000-0001-7374-4324, Maegele, Marc and Shander, Aryeh (2019). Tranexamic Acid for Acute Hemorrhage: A Narrative Review of Landmark Studies and a Critical Reappraisal of Its Use Over the Last Decade. Anesth. Analg., 129 (6). S. 1574 - 1585. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 0003-2999

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Abstract

The publication of the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage-2 (CRASH-2) study and its intense dissemination prompted a renaissance for the use of the antifibrinolytic agent tranexamic acid (TXA) in acute trauma hemorrhage. Subsequent studies led to its widespread use as a therapeutic as well as prophylactic agent across different clinical scenarios involving bleeding, such as trauma, postpartum, and orthopedic surgery. However, results from the existing studies are confounded by methodological and statistical ambiguities and are open to varied interpretations. Substantial knowledge gaps remain on dosing, pharmacokinetics, mechanism of action, and clinical applications for TXA. The risk for potential thromboembolic complications with the use of TXA must be balanced against its clinical benefits. The present article aims to provide a critical reappraisal of TXA use over the last decade and a thought exercise in the potential downsides of TXA. A more selective and individualized use of TXA, guided by extended and functional coagulation assays, is advocated in the context of the evolving concept of precision medicine.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lier, Heiko UNSPECIFIED orcid.org/0000-0001-7374-4324 UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Shander, Aryeh UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-126492
DOI:	10.1213/ANE.0000000000004389
Journal or Publication Title:	Anesth. Analg.
Volume:	129
Number:	6
Page Range:	S. 1574 - 1585
Date:	2019
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	0003-2999
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BLEEDING TRAUMA PATIENTS; POSTPARTUM HEMORRHAGE; FIBRINOLYSIS SHUTDOWN; STATISTICAL SIGNIFICANCE; SYNAPTIC-TRANSMISSION; MILITARY USE; P VALUES; MORTALITY; HYPERFIBRINOLYSIS; RESUSCITATION Multiple languages Anesthesiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12649