Injury is the second leading cause of death for people aged five to 45 years. Over three million people worldwide die of injuries, usually because of extensive blood loss. Antifibrinolytic drugs promote blood clotting by preventing blood clots from breaking down. Some examples of antifibrinolytic drugs are aprotinin, tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA). Doctors sometimes give these drugs to patients having surgery to prevent blood loss. They appear to have few complications. These drugs might also stop blood loss in seriously injured patients and, as a result, save lives.
The authors of this review searched for randomised trials assessing the effects of antifibrinolytics in trauma patients. When the review was first done in 2004 the results of the research were inconclusive. Since then, two new trials of TXA, one involving over 20,000 patients, have been completed. The results of this new research show that TXA reduces the risk of death compared to patients who receive no treatment without increasing the risk of adverse events.
Two small trials of aprotinin were also found although they provided no reliable data. Furthermore, since May 2008 aprotinin has been withdrawn from world markets in light of safety concerns.
The authors conclude that TXA can safely reduce death in bleeding trauma patients. They suggest that future trials should explore the effects of TXA in patients with traumatic brain injury with no other trauma.