| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 487.73 KB | Adobe PDF |
Authors
Abstract(s)
Introdução: A hemorragia gastrointestinal superior tem uma taxa de mortalidade
entre 2 e 14%. Apesar dos avanços médicos e cirúrgicos, a mortalidade por hemorragia
digestiva tem permanecido estável nos últimos 50 anos. O ácido tranexâmico é um
composto antifibrinolítico utilizado em diversos contextos de hemorragia aguda, entre
os quais no trauma, cirúrgico e pós-parto, com reconhecida eficácia e segurança. No
entanto, no contexto gastrointestinal a evidência científica não é consensual e as
orientações internacionais contraindicam o seu uso. Desta forma, torna-se fundamental
entender em que diferem os doentes com hemorragia gastrointestinal dos restantes
contextos hemorrágicos, e dissecar a evidência científica mais atual acerca do uso de
ácido tranexâmico neste contexto.
Objetivos: compilar e avaliar a evidência científica sobre o ácido tranexâmico na
hemorragia gastrointestinal, no que concerne à segurança e eficácia na redução da
mortalidade, bem como entender as diferenças entre estes doentes e os restantes
contextos de hemorragia aguda.
Metodologia: Análise de artigos de investigação acerca da utilização do ácido
tranexâmico no contexto de hemorragia gastrointestinal. Os artigos foram selecionados
das bases de dados PubMed/MEDLINE e Web of Science foi utilizada a estratégia de
pesquisa: ('tranexamic acid' OR ‘fibrinolytic agent*’) AND ('gastrointestinal bleeding'
OR 'gastrointestinal hemorrhage' OR ‘gastrointestinal haemorrhage’ OR ‘major
hemorrhage’ OR ‘major haemorrhage’).
Nesta análise foram considerados artigos na língua inglesa, portuguesa e espanhola, e
datados entre 2010 e 2023.
Resultados: O ácido tranexâmico é um antifibrinolítico eficaz na redução da
mortalidade por hemorragia. Parece haver um efeito dependente do tempo em que é
administrado o fármaco, sendo este mais eficaz quando administrado nas primeiras 3
horas, com reduzido efeito após este período. No entanto, o ácido tranexâmico parece
não ter a mesma eficácia no contexto de hemorragia digestiva, o que parece estar
indexado ao doente-tipo que apresenta diferenças significativas em relação aos restantes
contextos em que o fármaco é utilizado. Quando comparados com os doentes com
hemorragia por trauma, no pós-parto e lesões cerebrais traumáticas, os doentes com
hemorragia digestiva são cerca de 24 anos mais velhos, são tratados cerca de 9 horas
mais tarde desde o início da hemorragia, e têm mais comorbilidades. Além disso, estes pacientes padecem frequentemente de doença hepática crónica, apresentando perfis de
coagulação alterados que interferem com a ação do fármaco.
Conclusão: No contexto de hemorragia gastrointestinal aguda, o ácido tranexâmico
parece não reduzir a mortalidade, questionando-se a sua segurança. Tal parece
correlacionar-se com o doente-tipo, que difere quanto à idade média de apresentação,
comorbilidades associadas e tempo de evolução da hemorragia até à abordagem médica.
Em comparação com outras condições hemorrágicas, pacientes com hemorragia
digestiva são comumente mais idosos, com comorbidades, e procuram tardiamente os
serviços de saúde. Desconhece-se a eficácia e segurança do ácido tranexâmico em
doentes com hemorragia digestiva com condições clinicopatológicas similares aos
restantes contextos hemorrágicos.
Introduction: Upper gastrointestinal bleeding has a mortality rate between 2 and 14%. Despite medical and surgical advances, mortality due to gastrointestinal hemorrhage has remained stable over the past 50 years. Tranexamic acid is an antifibrinolytic compound used in various contexts of acute hemorrhage, including trauma, surgery and postpartum, with recognized efficacy and safety. However, in the upper gastrointestinal bleeding context, the scientific evidence is not consensual and international guidelines contraindicate its use. Thus, it is essential to understand how patients with gastrointestinal bleeding differ from other bleeding contexts and to dissect the most current scientific evidence on the use of tranexamic acid in this context. Objectives: To compile and evaluate the scientific evidence on tranexamic acid in gastrointestinal bleeding, regarding safety and efficacy in reducing mortality, as well as to understand the differences between these patients and other acute bleeding contexts. Methodology: Analysis of research articles on the use of tranexamic acid in the context of gastrointestinal bleeding. The articles were selected from the PubMed/MEDLINE and Web of Science databases, using the following search strategy: ('tranexamic acid' OR 'fibrinolytic agent*') AND ('gastrointestinal bleeding' OR 'gastrointestinal hemorrhage' OR 'gastrointestinal haemorrhage' OR 'major hemorrhage' OR 'major haemorrhage'). In this analysis, articles in English, Portuguese, and Spanish, and dated between 2010 and 2023, were considered. Results: Tranexamic acid is an effective antifibrinolytic in reducing mortality due to hemorrhage. There seems to be a relation between the time of administration and the effect: when administered in the first 3 hours, tranexamic acid is much more effective than when administered after this period. However, this drug does not seem to have the same efficacy in the context of gastrointestinal bleeding, which seems to be indexed to a role patient who shows significant differences from the other settings in which the drug is used. When compared to patients with trauma, postpartum bleeding and traumatic brain injuries, patients with GI bleeding are about 24 years older, are treated about 9 hours later from the onset of bleeding and have more comorbidities. In addition, these patients often suffer from chronic liver disease, with altered coagulation profiles, that interfere with the action of the drug. Conclusion: In the context of acute gastrointestinal hemorrhage, tranexamic acid does not seem to reduce mortality, and its safety is questioned. This seems to correlate with the role patient, which differs from other bleeding cases in terms of mean age of presentation, associated comorbidities, and time from bleeding to medical approach. Compared to other bleeding conditions, patients with gastrointestinal bleeding are commonly older, have more comorbidities, and seek health services later. The efficacy and safety of TXA in patients with GI bleeding with clinical and pathological features similar to other bleeding settings are unknown.
Introduction: Upper gastrointestinal bleeding has a mortality rate between 2 and 14%. Despite medical and surgical advances, mortality due to gastrointestinal hemorrhage has remained stable over the past 50 years. Tranexamic acid is an antifibrinolytic compound used in various contexts of acute hemorrhage, including trauma, surgery and postpartum, with recognized efficacy and safety. However, in the upper gastrointestinal bleeding context, the scientific evidence is not consensual and international guidelines contraindicate its use. Thus, it is essential to understand how patients with gastrointestinal bleeding differ from other bleeding contexts and to dissect the most current scientific evidence on the use of tranexamic acid in this context. Objectives: To compile and evaluate the scientific evidence on tranexamic acid in gastrointestinal bleeding, regarding safety and efficacy in reducing mortality, as well as to understand the differences between these patients and other acute bleeding contexts. Methodology: Analysis of research articles on the use of tranexamic acid in the context of gastrointestinal bleeding. The articles were selected from the PubMed/MEDLINE and Web of Science databases, using the following search strategy: ('tranexamic acid' OR 'fibrinolytic agent*') AND ('gastrointestinal bleeding' OR 'gastrointestinal hemorrhage' OR 'gastrointestinal haemorrhage' OR 'major hemorrhage' OR 'major haemorrhage'). In this analysis, articles in English, Portuguese, and Spanish, and dated between 2010 and 2023, were considered. Results: Tranexamic acid is an effective antifibrinolytic in reducing mortality due to hemorrhage. There seems to be a relation between the time of administration and the effect: when administered in the first 3 hours, tranexamic acid is much more effective than when administered after this period. However, this drug does not seem to have the same efficacy in the context of gastrointestinal bleeding, which seems to be indexed to a role patient who shows significant differences from the other settings in which the drug is used. When compared to patients with trauma, postpartum bleeding and traumatic brain injuries, patients with GI bleeding are about 24 years older, are treated about 9 hours later from the onset of bleeding and have more comorbidities. In addition, these patients often suffer from chronic liver disease, with altered coagulation profiles, that interfere with the action of the drug. Conclusion: In the context of acute gastrointestinal hemorrhage, tranexamic acid does not seem to reduce mortality, and its safety is questioned. This seems to correlate with the role patient, which differs from other bleeding cases in terms of mean age of presentation, associated comorbidities, and time from bleeding to medical approach. Compared to other bleeding conditions, patients with gastrointestinal bleeding are commonly older, have more comorbidities, and seek health services later. The efficacy and safety of TXA in patients with GI bleeding with clinical and pathological features similar to other bleeding settings are unknown.
Description
Keywords
Antifibrinolytic Agents Gastrointestinal Bleeding Hemorrhage Hemostasis Tranexamic Acid