Abstract:
BACKGROUND:Uncontrolled bleeding is an important cause of death in trauma victims. Antifibrinolytic treatment has been shown to reduce blood loss following surgery and may also be effective in reducing blood loss following trauma. OBJECTIVES:To assess the effect of antifibrinolytic drugs in patients with acute traumatic injury. SEARCH METHODS:We ran the most recent search in January 2015. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (OvidSP), PubMed and clinical trials registries. SELECTION CRITERIA:Randomised controlled trials of antifibrinolytic agents (aprotinin, tranexamic acid [TXA], epsilon-aminocaproic acid and aminomethylbenzoic acid) following acute traumatic injury. DATA COLLECTION AND ANALYSIS:From the results of the screened electronic searches, bibliographic searches, and contacts with experts, two authors independently selected trials meeting the inclusion criteria, and extracted data. One review author assessed the risk of bias for key domains.Outcome measures included: mortality at end of follow-up (all-cause); adverse events (specifically vascular occlusive events [myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism] and renal failure); number of patients undergoing surgical intervention or receiving blood transfusion; volume of blood transfused; volume of intracranial bleeding; brain ischaemic lesions; death or disability.We rated the quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach. MAIN RESULTS:Three trials met the inclusion criteria.Two trials (n = 20,451) assessed the effect of TXA. The larger of these (CRASH-2, n = 20,211) was conducted in 40 countries and included patients with a variety of types of trauma; the other (n = 240) restricted itself to those with traumatic brain injury (TBI) only.One trial (n = 77) assessed aprotinin in participants with major bony trauma and shock.The pooled data show that antifibrinolytic drugs reduce the risk of death from any cause by 10% (RR 0.90, 95% CI 0.85 to 0.96; P = 0.002) (quality of evidence: high). This estimate is based primarily on data from the CRASH-2 trial of TXA, which contributed 99% of the data.There is no evidence that antifibrinolytics have an effect on the risk of vascular occlusive events (quality of evidence: moderate), need for surgical intervention or receipt of blood transfusion (quality of evidence: high). There is no evidence for a difference in the effect by type of antifibrinolytic (TXA versus aprotinin) however, as the pooled analyses were based predominantly on trial data concerning the effects of TXA, the results can only be confidently applied to the effects of TXA. The effects of aprotinin in this patient group remain uncertain.There is some evidence from pooling data from one study (n = 240) and a subset of data from CRASH-2 (n = 270) in patients with TBI which suggest that TXA may reduce mortality although the estimates are imprecise, the quality of evidence is low, and uncertainty remains. Stronger evidence exists for the possibility of TXA reducing intracranial bleeding in this population. AUTHORS' CONCLUSIONS:TXA safely reduces mortality in trauma patients with bleeding without increasing the risk of adverse events. TXA should be given as early as possible and within three hours of injury, as further analysis of the CRASH-2 trial showed that treatment later than this is unlikely to be effective and may be harmful. Although there is some promising evidence for the effect of TXA in patients with TBI, substantial uncertainty remains.Two ongoing trials being conducted in patients with isolated TBI should resolve these remaining uncertainties.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Ker K,Roberts I,Shakur H,Coats TJdoi
10.1002/14651858.CD004896.pub4subject
Has Abstractpub_date
2015-05-09 00:00:00pages
CD004896issue
5issn
1469-493Xpub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intraocular pressure. The surgery involves creating a channel through the sclera, through which intraocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel, intraocular p...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001132.pub2
更新日期:2014-02-19 00:00:00
abstract:BACKGROUND:Nedocromil sodium and sodium cromoglycate inhaled shortly before exercise appear to reduce the severity of exercise-induced bronchoconstriction. There is some debate over which drug may be more effective. OBJECTIVES:The objective of this review was to compare the effects on post-exercise lung function betwe...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002731
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:There are no clearly effective treatments for the cough of acute bronchitis, and beta2-agonists are often prescribed, perhaps because clinicians suspect many patients also have reversible airflow restriction contributing to the symptoms. OBJECTIVES:To determine whether beta2-agonists improve symptoms of acu...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001726.pub3
更新日期:2006-10-18 00:00:00
abstract:BACKGROUND:Amantadine hydrochloride and rimantadine hydrochloride have antiviral properties, but they are not widely used due to a lack of knowledge of their potential value and concerns about possible adverse effects. OBJECTIVES:The objective of this review was to assess the effects and safety of amantadine and riman...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001169
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abstract:BACKGROUND:During aortic aneurysm surgery, cross-clamping can lead to inadequate blood supply to the spinal cord resulting in neurological deficit. Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to the spinal cord and hence reduce the risk of ischaemic spinal cord injury. OBJECTIVES:To determi...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003635.pub3
更新日期:2012-10-17 00:00:00
abstract:BACKGROUND:Herpes simplex virus (HSV) is a rare but serious neonatal pathogen. Prior to the availability of antiviral drugs the mortality associated with all but localised neonatal infection was high, with 85% of infants with disseminated HSV infection and 50% of infants with encephalitis dying by one year of age. The ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004206.pub2
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002850
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Controlled trials over two decades ago showed that the polysaccharide vaccine prevented meningococcal meningitis. Subsequent observational studies suggested variations in the level and duration of protection, particularly among young children. OBJECTIVES:To determine the effect of polysaccharide serogroup A...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD001093
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abstract:BACKGROUND:It is believed that ivermectin (a microfilaricide) could prevent blindness due to onchocerciasis. However, when given to everyone in communities where onchocerciasis is common, the effects of ivermectin on lesions affecting the eye are uncertain and data on whether the drug prevents visual loss is unclear. ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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abstract:BACKGROUND:Branch retinal vein occlusion (BRVO) is one of the most common occurring retinal vascular abnormalities. The pathogenesis of BRVO is thought to involve both retinal vein compression and damage to the vessel wall, possibly leading to thrombus formation at sites where retinal arterioles cross retinal veins. Th...
journal_title:The Cochrane database of systematic reviews
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006537.pub3
更新日期:2015-10-23 00:00:00
abstract:BACKGROUND:The principal factors that decide how deafness affects a child's development are the degree of hearing impairment and the age at which it is diagnosed. A number of factors are thought to increase the risk of hearing impairment: low birth weight, prematurity, perinatal hypoxia and jaundice, among others. The ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD003731.pub3
更新日期:2010-01-20 00:00:00
abstract:BACKGROUND:Clozapine is an atypical antipsychotic demonstrated to be superior in the treatment of refractory schizophrenia which causes fewer movement disorders. Clozapine, however, entails a significant risk of serious blood disorders such as agranulocytosis which could be potentially fatal. Currently there are a numb...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006633.pub2
更新日期:2010-11-10 00:00:00
abstract:BACKGROUND:Postmenopausal osteoporosis results in an increased susceptibility to low-trauma fractures due to reduced bone volume and microarchitectural deterioration. Risedronate, a third generation bisphosphonate, has been shown in multiple clinical trials to reduce fracture risk and improve bone mineral density in po...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004523
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Cystic fibrosis (CF) is the commonest inherited life-shortening illness in white populations, caused by a mutation in the gene that codes for the cystic fibrosis transmembrane regulator protein (CFTR), which functions as a salt transporter. This mutation mainly affects the airways where excess salt absorptio...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD009841.pub3
更新日期:2019-01-07 00:00:00
abstract:BACKGROUND:Acute splenic sequestration crises are a complication of sickle cell disease, with high mortality rates and frequent recurrence in survivors of first attacks. Splenectomy and blood transfusion, with their consequences, are the mainstay of long-term management used in different parts of the world. This is a 2...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD003425.pub4
更新日期:2017-11-07 00:00:00
abstract:BACKGROUND:Elective caesarean delivery for women in labour with a small or immature baby might reduce the chances of fetal or neonatal death, but it might also increase the risk of maternal morbidity. OBJECTIVES:To assess the effects of a policy of elective caesarean delivery versus expectant management for small babi...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000078
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Ventilated newborn infants breathing in asynchrony with the ventilator are at risk for complications during mechanical ventilation, such as pneumothorax or intraventricular hemorrhage, and are exposed to more severe barotrauma, which consequently could impair their clinical outcome. Neuromuscular paralysis, ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002773
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Ulnar neuropathy at the elbow is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical but optimal management remains controversial. This is an update of a review first published in 2010. OBJECTIVES:To determine the effectiveness and safety of c...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006839.pub3
更新日期:2012-07-11 00:00:00
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journal_title:The Cochrane database of systematic reviews
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更新日期:2003-01-01 00:00:00
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journal_title:The Cochrane database of systematic reviews
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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更新日期:2000-01-01 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006864
更新日期:2007-10-17 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
doi:10.1002/14651858.CD012855.pub2
更新日期:2019-05-20 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2017-09-25 00:00:00
abstract:BACKGROUND:Research on the clinical application of oral naltrexone agrees on several things. From a pharmacological perspective, naltrexone works. From an applied perspective, however, the medication compliance and the retention rates are very poor. OBJECTIVES:To evaluate the effects of naltrexone maintenance treatmen...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2011-02-16 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006424.pub3
更新日期:2014-09-04 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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更新日期:2005-01-25 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008056.pub2
更新日期:2013-07-12 00:00:00
abstract:BACKGROUND:Adhesions are the leading cause of small bowel obstruction. Gastrografin transit time may allow for the selection of appropriate patients for non-operative management. Some studies have shown when the contrast does not reach the colon after a designated time it indicates complete intestinal obstruction that ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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更新日期:2007-07-18 00:00:00