Mar 23, 2020

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

British Journal of Anaesthesia
Francois-Xavier AgeronAntifibrinolytics Trials Collaboration


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 ...Continue Reading

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Mentioned in this Paper

Postpartum Hemorrhage
Cessation of Life
Acute Hemorrhage
Intermediate Risk
Antifibrinolytic Agents
Clinical Trials
Tranexamic Acid
Meta Analysis (Statistical Procedure)
Antifibrinolytic amino acids

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