Moen Christian Arvei, Burrell Amy, Dunning Joel
Department of Clinical Science, University of Bergen, Bergen, Norway.
Interact Cardiovasc Thorac Surg. 2013 Dec;17(6):991-4. doi: 10.1093/icvts/ivt383. Epub 2013 Aug 21.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does tranexamic acid stop haemoptysis'? Altogether 49 papers were found using the reported search strategy, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This consisted of one systematic review including a meta-analysis of two double-blind randomized controlled trials (RCTs), the two RCTs, one cohort study, two case-series and seven case reports. Main outcomes included bleeding time, bleeding volume and occurrence of thromboembolic complications after start of treatment. Based on results from the meta-analysis, no difference in remission of bleeding within 1 week was found between tranexamic acid (TA) and placebo groups (odds ratio 1.56, 95% CI: 0.44-5.46). However, overall bleeding time was significantly shorter for the TA group (weighted mean difference -19.47, 95% CI: -26.90, -12.03 h). In one RCT, TA reduced both the duration and the volume of bleeding compared with patients receiving placebo (both P < 0.0005). However, the other RCT failed to find a difference in bleeding time (P = 0.2). In these studies, no patient suffered from thromboembolic complications. Two case reports, however, describe development of pulmonary embolism during TA treatment. Several case reports on the use of TA for treatment of haemoptysis secondary to cystic fibrosis were found. In general, they suggest that TA may be a useful and well-tolerated medication for the treatment of intractable haemoptysis in this patient group. We conclude that limited research on the use of TA for treatment of haemoptysis exists. As aetiology of haemoptysis as well as length of treatment, dosage and form of TA administration varied between the studies, strong recommendations are difficult to give. Current best evidence, however, indicates that TA may reduce both the duration and volume of bleeding, with low risk of short-term thromboembolic complications, in patients with haemoptysis.
一篇胸外科的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“氨甲环酸能否止住咯血？”使用报告的检索策略共找到49篇论文，其中13篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、所研究的患者群体、研究类型、相关结局和结果均列于表格中。这包括一项系统评价，其中包含对两项双盲随机对照试验（RCT）的荟萃分析、这两项RCT、一项队列研究、两项病例系列和七篇病例报告。主要结局包括治疗开始后的出血时间、出血量和血栓栓塞并发症的发生情况。基于荟萃分析的结果，氨甲环酸（TA）组和安慰剂组在1周内出血缓解方面未发现差异（优势比1.56，95%置信区间：0.44 - 5.46）。然而，TA组的总体出血时间明显更短（加权平均差 -19.47，95%置信区间：-26.90，-12.03小时）。在一项RCT中，与接受安慰剂的患者相比，TA减少了出血的持续时间和出血量（均P < 0.0005）。然而，另一项RCT未发现出血时间存在差异（P = 0.2）。在这些研究中，没有患者发生血栓栓塞并发症。然而，有两篇病例报告描述了TA治疗期间发生肺栓塞的情况。还发现了几篇关于使用TA治疗囊性纤维化继发咯血的病例报告。总体而言，它们表明TA可能是该患者群体中治疗难治性咯血的一种有用且耐受性良好的药物。我们得出结论，关于使用TA治疗咯血的研究有限。由于各研究中咯血的病因以及TA的治疗时长、剂量和给药形式各不相同，因此难以给出强有力的推荐。然而，目前的最佳证据表明，TA可能会减少咯血患者的出血持续时间和出血量，且短期血栓栓塞并发症风险较低。
