Tranexamic acid in cardiac surgery is there a cause for concern 英文参考文献.docVIP

Royston Critical Care 2010,14:194 /content/14/5/194 COMMENTARY Tranexamic acid in cardiac surgery: is there a cause for concern? David Royston* See related research by Sander et al., /content/14/4/R148 agent for use during major cardiac surgery. e two alter- Abstract na tives are the lysine analogues epsilon aminocaproic acid and tranexamic acid. Epsilon aminocaproic acid has no approval in Europe or Canada for human adminis- tration, leading to the exclusive use of tranexamic acid in these countries. The withdrawal of marketing approval for aprotinin resulted in more clinicians administering tranexamic acid to patients at increased risk of bleeding and adverse outcome. The latest in a series of retrospective analyses of observational data is published in Critical Care and suggests an increase in mortality, when compared to data from the aprotinin era, in those patients having surgery when a cardiac chamber is opened. The added observation of an increase in cerebral excitatory phenomena (seizure activity) with tranexamic acid has a known mechanism and questions if such patients should be given this drug. is shift highlighted a number of problems concerning trane e ? rst was to de? ne an appropriate ere is only one study investigating a e? ective dos dose-response rela is article showed a plateau e? ect on drains losses with a total dose of 3 grams tranexamic acid but with no observed e? ect on trans fu- sions e population studied were patients having low- e second risk primary myocardial revascularisa problem is that there is no evidence for a bene? t of tranexamic acid to reduce transfusion burden in patients at higher risk for transfusions, such as those taking A recent article from the group in Berlin [1] reports on a retrospective review of observational data comparing aspirin prior to surgery [4] and those having prolonged their experience using tranexamic acid as an