Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network and Women's College Hospital, Toronto, ON, Canada.
Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2021 Jun;68(6):894-917. doi: 10.1007/s12630-021-01967-7. Epub 2021 May 15.
In this Continuing Professional Development module, we review the practical pharmacology of tranexamic acid and its clinical use in trauma, obstetrics, and major orthopedic surgery.
Tranexamic acid is a synthetic drug that inhibits fibrinolysis. Multiple clinical trials in various clinical settings have shown that it can reduce blood loss, transfusion rates, and bleeding-associated mortality. In trauma and obstetrical bleeding, early tranexamic acid administration (< three hours) may have greater clinical benefits. Overall, tranexamic acid use appears safe with no significant increase of thromboembolic or seizure events. Nevertheless, current evidence has limitations related to wide heterogeneity in dose, route, and timing of drug administration, as well as generalizability of the large-scale trial findings to higher income nations.
Tranexamic acid is an efficacious and safe pharmacological-based blood conservation technique in the management of clinically significant hemorrhage. All anesthesiologists should have a good understanding of the pharmacotherapeutic properties and perioperative role of tranexamic acid therapy both inside and outside of the operating room. The use of tranexamic acid is likely to continue to rise with endorsement by various clinical guidelines and healthcare organizations. Further quantitative research is needed to evaluate optimal dosing and drug efficacy in these clinical scenarios.
在本持续专业发展模块中，我们回顾了氨甲环酸的实用药理学及其在创伤、产科和大型骨科手术中的临床应用。
氨甲环酸是一种合成药物，可抑制纤维蛋白溶解。多项临床试验表明，氨甲环酸可减少失血量、输血率和出血相关死亡率。在创伤和产科出血中，早期给予氨甲环酸（<3 小时）可能具有更大的临床益处。总体而言，氨甲环酸的使用似乎是安全的，没有明显增加血栓栓塞或癫痫发作事件的风险。然而，目前的证据存在局限性，与药物给药剂量、途径和时间的广泛异质性以及大型试验结果在高收入国家的普遍性有关。
氨甲环酸是一种有效的、安全的药理学血液保护技术，可用于治疗临床上明显的出血。所有麻醉师都应该很好地了解氨甲环酸治疗的药物治疗特性和围手术期作用，无论是在手术室内部还是外部。随着各种临床指南和医疗保健组织的认可，氨甲环酸的使用可能会继续增加。需要进一步的定量研究来评估这些临床情况下的最佳剂量和药物疗效。
