Tranexamic acid in ruptured AAA
Date First Published:
January 17, 2015
Last Updated:
January 29, 2015
Report by:
Dr Peter Hulme, ST6 EM (Manchester Royal Infirmary)
Three-Part Question:
[In patients with ruptured AAA] does [tranexamic acid] [reduce mortality]
Clinical Scenario:
A 70 year old man presents with back pain and collapse. His pulse is 120 and BP 90/63. CT shows a ruptured abdominal aortic aneurysm. You wonder whether giving tranexamic acid would reduce his risk of death.
Search Strategy:
1.(aaa.ti,ab)
2.(abdominal AND aortic AND aneurysm).ti,ab
3.(tranexamic AND acid).ti,ab
4.(txa.ti,ab)t
5. MEDLINEt1 OR 2t
6. MEDLINEt3 OR 4
7. MEDLINEt5 AND 6
2.(abdominal AND aortic AND aneurysm).ti,ab
3.(tranexamic AND acid).ti,ab
4.(txa.ti,ab)t
5. MEDLINEt1 OR 2t
6. MEDLINEt3 OR 4
7. MEDLINEt5 AND 6
Search Details:
Medline 1946 to present
AMED 1985 to present
EMBASE 1980 to present
CINAL 1981 to present
AMED 1985 to present
EMBASE 1980 to present
CINAL 1981 to present
Outcome:
8 papers of which none entered the clinical question.
Author Commentary:
Tranexamic acid is a antifibrolytic drug used to prevent fibrin breakdown in blood clots. Recent evidence has shown it's benefits in reducing mortality in trauma and it has also been shown to improve outcomes and reduce the requirement for blood transfusions in orthopaedic and cardiothoracic surgery. There are theoretical reasons to believe that there may be benefits in using tranexamic acid in ruptured AAA to stabilize clot formation. There is an ongoing clinical trial in Canada (Effect of Tranexamic Acid in Ruptured Abdominal Aortic Aneurysms) which aims to answer this question.
Bottom Line:
There is currently no evidence to the support the use of tranexamic acid in patients with ruptured AAA.