Definition
Antifibrinolytic agents are drugs which block the conversion of plasminogen to plasmin, which is the enzyme responsible for the degradation of fibrin clots, a process called fibrinolysis. These agents can be used in trauma patients who are at risk of hemorrhage, by reducing clot breakdown, which can become pathologically upregulated (hyperfibrinolysis) following traumatic injury and shock (Hess et al. 2008).
Antifibrinolytic Drugs
The two principal antifibrinolytic agents available are aminocaproic acid and tranexamic acid (TXA); both of which are derivatives of the amino acid lysine. Aminocaproic acid has not been reported as a hemostatic adjunct in trauma and will not be discussed further. TXA competitively inhibits the activation of plasminogen by blocking the lysine-binding site. It has a biological half-life of 3.1 h, with negligible plasma protein binding and is excreted via the kidneys (Astedt 1987).
The CRASH-2 trial enrolled 20,211 patients, who either had or were...
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Astedt B (1987) Clinical pharmacology of Tranexamic acid. Scand J Gastroenterol Suppl 137:22–25
CRASH-2 Collaborators (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32
CRASH-2 Collaborators (2011) The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 377:1–6
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Morrison JJ, DuBose JJ, Rasmussen TE, Midwinter MJ (2012) Military Application of Tranexamic acid in Trauma Emergency Resuscitation (MATTERs) study. Arch Surg 147(2):113–119
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Morrison, J.J., Jansen, J.O. (2015). Adjuncts to Transfusion: Antifibrinolytics. In: Papadakos, P.J., Gestring, M.L. (eds) Encyclopedia of Trauma Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29613-0_16
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DOI: https://doi.org/10.1007/978-3-642-29613-0_16
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