Pinto Marcelo A, Silva Jair G da, Chedid Aljamir D, Chedid Marcio F
Division of General and Trauma Surgery, Hospital de Pronto Socorro Municipal de Porto Alegre.
Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul.
Arq Bras Cir Dig. 2016 Nov-Dec;29(4):282-286. doi: 10.1590/0102-6720201600040017.
Use of tranexamic acid (TXA) in trauma has been the subject of growing interest by researchers and health professionals. However, there are still several open questions regarding its use. In some aspects medical literature is controversial. The points of disagreement among experts include questions such as: Which patients should receive TXA in trauma? Should treatment be performed in the pre-hospital environment? Is there any need for laboratory parameters before starting TXA treatment? What is the drug safety profile? The main issue on which there is still no basis in literature is: What is the indication for treatment within massive transfusion protocols?
Answer the questions proposed based on critical evaluation of the evidence gathered so far and carry out a study of cost-effectiveness of TXA use in trauma adapted to the Brazilian reality.
A literature review was performed through searching Pubmed.com, Embase and Cab Abstract by headings "tranexamic AND trauma", in all languages, yielding 426 articles. Manuscripts reporting on TXA utilization for elective procedures were excluded, remaining 79 articles. Fifty-five articles were selected, and critically evaluated in order to answer study questions. The evaluation of cost effectiveness was performed using CRASH-2 trial data and Brazilian official population data.
TXA is effective and efficient, and should be administered to a wide range of patients, including those with indication evaluated in research protocols and current indication criteria for TXA should be expanded. As for the cost-effectiveness, the TXA proved to be cost-effective with an average cost of R$ 61.35 (currently US$16) per year of life saved.
The use of TXA in trauma setting seems to be effective, efficient and cost-effective in the various groups of polytrauma patients. Its use in massive transfusion protocols should be the subject of further investigations.
氨甲环酸（TXA）在创伤治疗中的应用一直是研究人员和医疗专业人员日益关注的话题。然而，关于其使用仍存在几个悬而未决的问题。在某些方面，医学文献存在争议。专家之间的分歧点包括以下问题：哪些创伤患者应接受TXA治疗？治疗应在院前环境中进行吗？开始TXA治疗前是否需要实验室参数？药物安全性如何？文献中仍无依据的主要问题是：在大量输血方案中治疗的指征是什么？
根据对迄今收集的证据的批判性评估，回答提出的问题，并开展一项针对适应巴西实际情况的创伤患者使用TXA的成本效益研究。
通过在Pubmed.com、Embase和Cab Abstract上按“氨甲环酸与创伤”标题进行搜索，以所有语言进行文献综述，共获得426篇文章。排除报告TXA用于择期手术的手稿，剩余79篇文章。选取55篇文章进行批判性评估，以回答研究问题。使用CRASH - 2试验数据和巴西官方人口数据进行成本效益评估。
TXA有效且高效，应给予广泛的患者使用，包括那些在研究方案中评估有指征的患者，并且目前TXA的指征标准应扩大。至于成本效益，TXA被证明具有成本效益，平均每挽救一年生命的成本为61.35雷亚尔（目前为16美元）。
在各类多发伤患者中，TXA在创伤治疗中的应用似乎有效、高效且具有成本效益。其在大量输血方案中的应用应是进一步研究的主题。
