Bouras Marwan, Bourdiol Alexandre, Rooze Paul, Hourmant Yannick, Caillard Anaïs, Roquilly Antoine
CHU Brest, Anesthesiology and Intensive Care Unit, Brest, France.
INSERM UMR 1064 CR2TI, University of Nantes, Nantes, France.
Front Med (Lausanne). 2024 Aug 7;11:1416998. doi: 10.3389/fmed.2024.1416998. eCollection 2024.
Tranexamic acid (TXA) is the most widely prescribed antifibrinolytic for active bleeding or to prevent surgical bleeding. Despite numerous large multi-center randomized trials involving thousands of patients being conducted, TXA remains underutilized in indications where it has demonstrated efficacy and a lack of harmful effects. This narrative review aims to provide basic concepts about fibrinolysis and TXA's mode of action and is focused on the most recent and important trials evaluating this drug in different hemorrhagic situations.
We selected every low bias RCT, and we highlighted their strengths and limitations throughout this review.
While TXA appears to have a favorable benefit-risk ratio in most situations (trauma, obstetrics, at-risk for bleeding surgeries) evidence of benefit is lacking in certain medical settings (SAH, digestive bleeding).
Although in some situations the drug's effect on significant outcomes is modest, its favorable safety profile allows it to be recommended for trauma patients, in obstetrics, and in scheduled surgeries at risk of bleeding. However, it cannot be recommended in cases of spontaneous intracranial bleeding, subarachnoid hemorrhage (SAH), or gastrointestinal bleeding.
氨甲环酸（TXA）是治疗活动性出血或预防手术出血时处方最广泛的抗纤溶药物。尽管已经开展了涉及数千名患者的众多大型多中心随机试验，但在已证明其有效性且无有害影响的适应症中，TXA的使用仍未得到充分利用。本叙述性综述旨在提供关于纤维蛋白溶解和TXA作用方式的基本概念，并重点关注评估该药物在不同出血情况下的最新且重要的试验。
我们筛选了所有低偏倚的随机对照试验，并在本综述中突出了它们的优势和局限性。
虽然TXA在大多数情况下（创伤、产科、出血风险手术）似乎具有良好的效益风险比，但在某些医疗环境（蛛网膜下腔出血、消化道出血）中缺乏获益证据。
尽管在某些情况下该药物对显著结局的影响不大，但其良好的安全性使其可推荐用于创伤患者、产科患者以及有出血风险的择期手术患者。然而，对于自发性颅内出血、蛛网膜下腔出血（SAH）或胃肠道出血病例，不推荐使用。
