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The results of this review show that tranexamic acid reduces the probability that a patient will receive a blood transfusion by around 30%. The effect of tranexamic acid on other important outcomes, such as death, remains uncertain. The authors conclude that larger studies should be done to assess the effects of tranexamic acid on relevant outcomes such as death in patients undergoing all types of emergency and urgent surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 31, 2013

Blood loss during liver resection (partial removal of liver) is one of the important factors affecting the post‐operative complications of patients. Allogeneic blood transfusion (using blood donated by a different individual) is associated with increased morbidity and lower survival in patients with liver cancer. This systematic review was aimed at determining whether any medical treatment decreased blood loss and decreased allogeneic blood transfusion requirements in patients undergoing liver resections. This systematic review included six trials with 849 patients. All trials had high risk of bias ('systematic error') as well of play of chance ('random error'). The trials included comparison of medicines (such as aprotinin, desmopressin, recombinant factor VIIa, antithrombin III, and tranexamic acid) with controls (no medicines). There was no difference in the death or complications due to surgery or long‐term survival in any of the comparisons. Fewer patients required transfusion of blood donated by others when aprotinin or tranexamic acid were compared to controls not receiving the interventions. The other comparisons did not decrease the transfusion requirements. However, there is a high risk of type I errors (erroneously concluding that an intervention is beneficial when it is actually not beneficial) and type II errors (erroneously concluding that an intervention is not beneficial when it is actually beneficial) because of the few trials included and the small sample size in each trial as well as the inherent risk of bias (systematic errors). Aprotinin and tranexamic acid show promise in the reduction of blood transfusion requirements in liver resections. Further randomised clinical trials with low risk of bias (systematic errors) and low risk of play of chance (random errors) which assess clinically important outcomes (such as death and complications due to operation) are necessary to assess any pharmacological interventions aimed at decreasing blood transfusion and blood transfusion requirements in liver resections. Trials need to be designed to assess the effect of a combination of different interventions in liver resections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 7, 2009

Cytoreductive surgery (also called debulking) is a standard surgical procedure for advanced epithelial ovarian cancer. During surgery, the aim is to remove not only the ovaries, but also the uterus, fallopian tubes, and as much of the visible tumour as possible. Blood loss during cytoreductive surgery has long been recognised as a contributor to prolonged recovery time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 23, 2016

Background: Cervical cancer (cancer of the neck of the womb) is the second most common cancer among women throughout the world, accounting for about 500,000 new detected cases and 273,000 deaths every year. Women more commonly present with advanced disease in the developing world, where access to cervical screening programmes is limited. Advanced cancer of the cervix may not be curable and women often need treatment to control distressing symptoms (palliation), such as vaginal bleeding. Bleeding can be severe enough to be life threatening in women with advanced cervical cancer. Management of vaginal bleeding often poses a challenge, especially in the developing world, where access to radiotherapy is limited. Options for palliative treatment of severe vaginal bleeding include interventional radiology treatment (using x‐rays to guide the insertion of 'plugs' into blood vessels supplying the cancer) or vaginal packing (where gauze is compacted into the vagina to absorb the blood and apply pressure directly to the cervix), although these are often only partly effective and may cause harm. Vaginal packs can be soaked with formalin, which is a preservative chemical. Other options for treating severe vaginal bleeding include tranexamic acid (a medicine that reduces bleeding that can be given by mouth or by injection) and radiotherapy (high‐energy x‐ray treatment).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 1, 2015

Upper gastrointestinal bleeding is a common reason for emergency hospital admission. The prognosis is serious. Some patients may die as the result of uncontrolled bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 21, 2014

Postpartum haemorrhage is a common and an occasionally life‐threatening complication of labour. The majority of women receive drugs that directly stimulate the uterus (prophylactic uterotonics) during childbirth to prevent haemorrhages resulting from failure of the uterine muscle to contract normally (uterine atony).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 16, 2015

We evaluated the evidence about whether giving antifibrinolytics (tranexamic acid or epsilon‐aminocaproic acid) to people with a low platelet count prevents bleeding and whether these antifibrinolytics are associated with side effects. Our target population was people with haematological disorders who have a low platelet count and would usually be treated with platelet transfusions. We did not include people with immune thrombocytopenia because they are not usually treated with platelet transfusions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 15, 2016

Haemoptysis is the coughing up of blood or of blood‐stained sputum from the lower respiratory tract. It is a common pathology around the world and can be caused by a number of different diseases, including bronchitis, pneumonia, lung cancer, and tuberculosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 2, 2016

Heavy menstrual bleeding (more than 80mls blood loss per menstrual cycle) is a common problem for women and can have a negative effect on their quality of life. In comparison to women with normal menstrual blood loss, these women have more enzymes in the lining of the uterus that dissolve blood clots. Options to avoid surgery include antifibrinolytic therapy (taking drugs to block these enzymes). The review of trials found that tranexamic acid, the most commonly used antifibrinolytic agent helps reduce heavy menstrual bleeding. Problems with flooding, leakage and sex lives are also reduced. No adverse effects were found. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 23, 2000

In haemophilia and other congenital bleeding disorders blood does not clot properly, which can cause excessive bleeding. This is particularly relevant during surgery, when the risk of bleeding depends on the type and severity of the clotting disorder and on the type of surgery. Therefore, during and after surgery, these individuals should receive treatment to improve the ability of their blood to clot and so prevent bleeding. Clotting factor concentrates (when available and appropriate in those individuals missing specific clotting proteins) or other non‐specific drugs for clotting, or a combination of both, are administered. It is not known what is the optimal dose or duration or method of administration of these treatments in these circumstances.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 9, 2015

Hundreds of thousands of people worldwide suffer ill health caused by severe bleeding. Tranexamic acid is a drug that helps blood to clot and so it could help people who are bleeding. We already know that giving tranexamic acid intravenously (directly into the vein) reduces bleeding in accident victims and in patients having operations. But some doctors don't always give it this way because they are worried that it might have bad side effects in certain patients, such as causing blood clots where they are not wanted. An alternative way to give this drug is to mix it with sterile water and apply it directly to the bleeding surface (this is known as 'topical' application). Because less of the drug might be absorbed into the body when it is given this way, it could be less likely to have bad side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 23, 2013

Surgery for pre‐cancerous cervix lesions (cervical intraepithelial neoplasia) often causes significant bleeding during surgery or within 14 days. This review found that good surgical technique can reduce immediate blood loss and bleeding can also be reduced by some drugs. Vasopressin reduces blood flow by constricting blood vessels. Tranexamic acid reduces blood loss after knife and laser cone biopsy. Stitches also reduce blood loss but can interfere with later visual examination of the cervix.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 4, 2013

A subarachnoid haemorrhage (SAH) is a bleed into the small space between the brain and skull that contains blood vessels that supply the brain (the subarachnoid space). The cause of a bleeding here is usually a rupture of a weak spot in one of these vessels. A SAH is a relatively uncommon type of stroke, but it often occurs at a young age (half the patients are younger than 50 years). The outcome of SAH is often poor: one‐third of people die after the haemorrhage and of those who survive, one‐fifth will require help for everyday activities. An important cause of poor recovery after SAH is a second bleed from the weakened vessel (rebleeding). This is thought to be caused by the dissolving of the blood clot at the original bleeding site that results from natural blood clot dissolving (fibrinolytic) activity. Antifibrinolytic therapy that reduces this activity was introduced as a treatment for reducing rebleeding and therefore for improving recovery after SAH. This review included 10 trials, totaling 1904 participants that investigated the effect of these drugs in people with SAH. Antifibrinolytic treatment does indeed reduce the risk of rebleeding, but does not improve survival or the chance of being independent in everyday activities. This may be due to an increase in one of the other common complications of SAH. We conclude that antifibrinolytic treatment should not routinely be given to people with SAH, but new randomised trials are needed to establish if short‐term treatment might be beneficial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 30, 2013

Aprotinin, although effective in reducing bleeding, had a higher rate of death than tranexamic acid and aminocaproic acid, which appeared free of serious side‐effects. Aprotinin has been withdrawn from world markets because of safety concerns. This review of over 250 clinical trials found that anti‐fibrinolytic drugs used at the time of major surgery reduce bleeding, the need for transfusions of red blood cells and the need for repeat surgery because of bleeding. With the exception of aprotinin the drugs appear safe.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 16, 2011

This is an update of an existing Cochrane review, the last version was published in 2012.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 9, 2015

We reviewed the clinical benefits and harms of anticoagulant and antifibrinolytic therapy for treating disseminated intravascular coagulation (DIC) in patients with acute or chronic leukemia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 24, 2015

We reviewed the evidence about the effect and safety of non‐surgical treatments versus each other, placebo or no treatment for reducing menstrual blood loss in women with bleeding disorders. This is an update of a previously published Cochrane Review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 10, 2016

We reviewed the evidence about whether antifibrinolytic medicine (drugs that promote blood clotting) such as tranexamic acid or epsilon aminocaproic acid, can prevent oral bleeding in people with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 24, 2015

We evaluated the evidence about whether giving agents that can replace, or reduce platelet transfusion (artificial platelets, platelet‐poor plasma, fibrinogen concentrate, recombinant activated factor VII (rFVIIa), recombinant factor XIII (rFXIII), recombinant interleukin (rIL)6 or rIL11, desmopressin (DDAVP), thrombopoietin (TPO) mimetics or antifibrinolytic drugs), to people with a low platelet count prevents bleeding and whether these alternative agents are associated with side effects. Our target population was people with bone marrow disorders which prevent them from producing enough platelets. We excluded people undergoing intensive chemotherapy or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 31, 2016

The liver is the powerhouse of the body. It acts as a store of energy and a centre of metabolic activity. Liver transplantation is the main treatment for severe liver disease resulting in destruction of the liver (which can happen suddenly or over a period of time) due to various causes including alcoholism, viral infections, and autoimmune diseases. Liver transplantation is a major surgical procedure and is associated with significant loss of blood. Various methods have been used to decrease blood loss and transfusion requirements in patients undergoing liver transplantation, with a view to improve the results of liver transplantation. We performed a detailed review of the medical literature (available until September 2011) to determine the benefits and harms of different methods of decreasing blood loss and transfusion requirements in patients undergoing liver transplantation. We sought evidence from randomised clinical trials only, as when conducted properly such studies provide the best evidence. Two authors independently identified the trials and obtained the information from the trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 7, 2011

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

  • The risk associated with aprotinin in cardiac surgery.[N Engl J Med. 2006]
    The risk associated with aprotinin in cardiac surgery.
    Mangano DT, Tudor IC, Dietzel C, Multicenter Study of Perioperative Ischemia Research Group., Ischemia Research and Education Foundation.. N Engl J Med. 2006 Jan 26; 354(4):353-65.
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