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Meta-Analysis
. 2016 Mar 15;3(3):CD009733.
doi: 10.1002/14651858.CD009733.pub3.

Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders

Lise J Estcourt  1 , Michael Desborough, Susan J Brunskill, Carolyn Doree, Sally Hopewell, Michael F Murphy, Simon J Stanworth
Affiliations
Meta-Analysis

Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders

Lise J Estcourt et al. Cochrane Database Syst Rev. .

Abstract

Background: People with haematological disorders are frequently at risk of severe or life-threatening bleeding as a result of thrombocytopenia (reduced platelet count). This is despite the routine use of prophylactic platelet transfusions to prevent bleeding once the platelet count falls below a certain threshold. Platelet transfusions are not without risk and adverse events may be life-threatening. A possible adjunct to prophylactic platelet transfusions is the use of antifibrinolytics, specifically the lysine analogues tranexamic acid (TXA) and epsilon aminocaproic acid (EACA). This is an update of a Cochrane review first published in 2013.

Objectives: To determine the efficacy and safety of antifibrinolytics (lysine analogues) in preventing bleeding in people with haematological disorders.

Search methods: We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (The Cochrane Library 2016, Issue 3), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950) and ongoing trial databases to 07 March 2016.

Selection criteria: We included RCTs involving participants with haematological disorders, who would routinely require prophylactic platelet transfusions to prevent bleeding. We only included trials involving the use of the lysine analogues TXA and EACA.

Data collection and analysis: Two review authors independently screened all electronically-derived citations and abstracts of papers, identified by the review search strategy, for relevancy. Two review authors independently assessed the full text of all potentially relevant trials for eligibility, completed the data extraction and assessed the studies for risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. We requested missing data from one author but the data were no longer available. The outcomes are reported narratively: we performed no meta-analyses because of the heterogeneity of the available data.

Main results: We identified three new studies in this update of the review. In total seven studies were eligible for inclusion, three were ongoing RCTs and four were completed studies. The four completed studies were included in the original review and the three ongoing studies were included in this update. We did not identify any RCTs that compared TXA with EACA.Of the four completed studies, one cross-over TXA study (eight participants) was excluded from the outcome analysis because it had very flawed study methodology. Data from the other three studies were all at unclear risk of bias due to lack of reporting of study methodology.Three studies (two TXA (12 to 56 participants), one EACA (18 participants) reported in four articles (published 1983 to 1995) were included in the narrative review. All three studies compared the drug with placebo. All three studies included adults with acute leukaemia receiving chemotherapy. One study (12 participants) only included participants with acute promyelocytic leukaemia. None of the studies included children. One of the three studies reported funding sources and this study was funded by a charity.We are uncertain whether antifibrinolytics reduce the risk of bleeding (three studies; 86 participants; very low-quality evidence). Only one study reported the number of bleeding events per participant and there was no difference in the number of bleeding events seen during induction or consolidation chemotherapy between TXA and placebo (induction; 38 participants; mean difference (MD) 1.70 bleeding events, 95% confidence interval (CI) -0.37 to 3.77: consolidation; 18 participants; MD -1.50 bleeding events, 95% CI -3.25 to 0.25; very low-quality evidence). The two other studies suggested bleeding was reduced in the antifibrinolytic study arm, but this was statistically significant in only one of these two studies.Two studies reported thromboembolism and no events occurred (68 participants, very low-quality evidence).All three studies reported a reduction in platelet transfusion usage (three studies, 86 participants; very low-quality evidence), but this was reported in different ways and no meta-analysis could be performed. No trials reported the number of platelet transfusions per participant. Only one study reported the number of platelet components per participant and there was a reduction in the number of platelet components per participant during consolidation chemotherapy but not during induction chemotherapy (consolidation; 18 participants; MD -5.60 platelet units, 95% CI -9.02 to -2.18: induction; 38 participants, MD -1.00 platelet units, 95% CI -9.11 to 7.11; very low-quality evidence).Only one study reported adverse events of TXA as an outcome measure and none occurred. One study stated side effects of EACA were minimal but no further information was provided (two studies, 74 participants, very low-quality evidence).None of the studies reported on the following pre-specified outcomes: overall mortality, adverse events of transfusion, disseminated intravascular coagulation (DIC) or quality of life (QoL).

Authors' conclusions: Our results indicate that the evidence available for the use of antifibrinolytics in haematology patients is very limited. The trials were too small to assess whether or not antifibrinolytics decrease bleeding. No trials reported the number of platelet transfusions per participant. The trials were too small to assess whether or not antifibrinolytics increased the risk of thromboembolic events or other adverse events. There are three ongoing RCTs (1276 participants) due to be completed in 2017 and 2020.

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Conflict of interest statement

Lise Estcourt: chief investigator on one of the ongoing studies, partly funded by the NIHR Cochrane Programme Grant ‐ Safe and Appropriate Use of Blood Components.

Michael Desborough: none declared.

Susan Brunskill: none declared.

Sally Hopewell: partly funded by the NIHR Cochrane Programme Grant ‐ Safe and Appropriate Use of Blood Components.

Carolyn Doree: none declared.

Simon Stanworth: chief investigator on one of the ongoing studies.

Mike Murphy: investigator on one of the ongoing studies.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Tranexamic acid versus placebo, Outcome 1 Number of bleeding events per participant.
1.2
1.2. Analysis
Comparison 1 Tranexamic acid versus placebo, Outcome 2 Number of platelet components per participant.
1.3
1.3. Analysis
Comparison 1 Tranexamic acid versus placebo, Outcome 3 Number of red cell components per participant.
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References

References to studies included in this review

Avvisati 1989 {published data only}
    1. Avvisati G, Cate JW, Buller HR, Mandelli F. Tranexamic acid for control of haemorrhage in acute promyelocytic leukaemia. Lancet 1989;334(8655):122‐4. - PubMed
Fricke 1991 {published data only}
    1. Fricke W, Alling D, Kimble J, Griffith P, Klein H. Lack of efficacy of tranexamic acid in thrombocytopenic bleeding. Transfusion 1991;31(4):345‐8. - PubMed
Gallardo 1983 {published data only}
    1. Gallardo RL, Gardner FH. Antifibrinolytic therapy for bleeding control during remission induction for acute leukemia. Blood 1983;62:202a.
Shpilberg 1995 {published data only}
    1. Shpilberg O, Blumenthal R, Sofer O, Eldor A, Ben‐Bassat I. A controlled trial of tranexamic acid (TA) treatment for reduction of bleeding during acute myeloid leukemia (AML) induction and consolidation. Blood 1993;82:547a. - PubMed
    1. Shpilberg O, Blumenthal R, Sofer O, Katz Y, Chetrit A, Ramot B, et al. A controlled trial of tranexamic acid therapy for the reduction of bleeding during treatment of acute myeloid leukemia. Leukemia and Lymphoma 1995;19:141‐4. - PubMed

References to studies excluded from this review

Amar 2003 {published data only}
    1. Amar D, Grant FM, Zhang H, Boland PJ, Leung DH, Healey JA. Antifibrinolytic therapy and perioperative blood loss in cancer patients undergoing major orthopedic surgery. Anesthesiology 2003;98:337‐42. - PubMed
Antun 2013 {published data only}
    1. Antun AG, Gleason S, Arellano M, Langston AA, McLemore ML, Gaddh M, et al. Epsilon aminocaproic acid prevents bleeding in severely thrombocytopenic patients with hematological malignancies. Cancer 2013;119(21):3784‐7. - PubMed
Bartholomew 1989 {published data only}
    1. Bartholomew J, Salgia R, Bell W. Control of bleeding in patients with immune and non‐immune thrombocytopenia with aminocaproic acid. Archives of Internal Medicine 1989;149:1959‐61. - PubMed
Bates 2011 {published data only}
    1. Bates JS, Buie LW, Woodis CB. Management of menorrhagia associated with chemotherapy‐induced thrombocytopenia in women with hematologic malignancy. Pharmacotherapy 2011;11:1092‐110. - PubMed
Bedirhan 2001 {published data only}
    1. Bedirhan MA, Turna A, Yagan N, Tasci O. Aprotinin reduces postoperative bleeding and the need for blood products in thoracic surgery: results of a randomized double‐blind study. European Journal of Cardio‐thoracic Surgery 2001;20:1122‐7. - PubMed
Ben‐Bassat 1990 {published data only}
    1. Ben‐Bassat I, Douer D, Ramot B. Tranexamic acid therapy in acute myeloid leukemia: possible reduction of platelet transfusions. European Journal of Haematology 1990;45:86‐9. - PubMed
Breen 2012 {published data only}
    1. Breen KA, Grimwade D, Hunt BJ. The pathogenesis and management of the coagulopathy of acute promyelocytic leukaemia. British Journal of Haematology 2011;156:24‐36. - PubMed
Brown 2002 {published data only}
    1. Brown SA, Aledort LM, Lee CA. Haemostasis: from bench to bedside. Haemophilia 2002;8:685‐93. - PubMed
Byams 2007 {published data only}
    1. Byams VR, Dowling NF, Heit JA, Kouides PA, Philipp CS, Stein SF, et al. Quality of life (QOL) evaluation in women with menorrhagia and abnormal hemostasis testing participating in a cross‐over study of intranasal desmopressin and oral tranexamic acid. Journal of Thrombosis and Hemostasis 2007;5(2):P‐S‐189.
Cattan 1963 {published data only}
    1. Cattan A, Schwarzenberg L, Schneider M, Amiel J‐L, Mathé G. Trial of epsilon‐amino‐caproic acid in patients with a bleeding disorder, in particular thrombocytopenic disorders [Essai de traitement par l'acide epsilon‐amino‐caproique de patients atteints de syndrome hémorragiques, en particulier de syndromes liés a une thrombocytopénie]. La Presse Medicale 1963;71(43):2037‐8. - PubMed
Celebi 2006 {published data only}
    1. Celebi N, Celebioglu B, Selcuk M, Canbay O, Karagoz AH, Aypar U. The role of antifibrinolytic agents in gynecologic cancer surgery. Saudi Medical Journal 2006;27(5):637‐41. - PubMed
Chakrabarti 1998 {published data only}
    1. Chakrabarti S. Low dose bolus aminocaproic acid: an alternative to platelet transfusion in thrombocytopenia. European Journal of Haematology 1998;60:313‐4. - PubMed
Dean 1997 {published data only}
    1. Dean A, Tuffin P. Fibrinolytic inhibitors for cancer‐associated bleeding problems. Journal of Pain and Symptom Management 1997;3(1):20‐4. - PubMed
Fossa 1978 {published data only}
    1. Fossa SD, Solheim OO, Fossa JJ. Cyklokapron (tranexamic acid) in the treatment of patients with advanced neoplasms. Tidsskr Nor Laegeforen 1978;98(28):1368‐70. - PubMed
Gardner 1980 {published data only}
    1. Gardner FH, Helmer RE. Aminocaproic acid: use in control of hemorrhage in patients with amegakaryocytic thrombocytopenia. JAMA 1980;243(1):35‐7. - PubMed
Garewal 1985 {published data only}
    1. Garewal HS, Durie BGM. Anti‐fibrinolytic therapy with aminocaproic acid for the control of bleeding in thrombocytopenic patients. Scandinavian Journal of Haematology 1985;35:497‐500. - PubMed
Jeserschek 2003 {published data only}
    1. Jeserschek R, Clar H, Aigner C, Rehak P, Primus B, Windhager R. Reduction of blood loss using high‐dose aprotinin in major orthopaedic surgery. Journal of Bone and Joint Surgery 2003;85(2):174‐7. - PubMed
Kalmadi 2006 {published data only}
    1. Kalmadi S, Tiu R, Lowe C, Jin T, Kalaycio M. Epsilon aminocaproic acid reduces transfusion requirements in patients with thrombocytopenic hemorrhage. Cancer 2006;107(1):136‐40. - PubMed
Katzel 1998 {published data only}
    1. Katzel R, Keuper H, Wiedemann B, Brethner L, Viogt B. The effects of intraoperative aprotinin on perioperative haemostasis and fibrinolysis and their effects on blood loss and transfusion requirements in lung surgery [Effekte der intraoperativen Aprotininapplikation auf perioperative Haemostase und Fibrinolyseveraenderungen und ihre Auswirkungen auf Blutverlust und Transfusionsbedarf bei lungenchirurgischen Eingriffen]. Infusionstherapie und Transfusionsmedizin 1998;25:236‐45.
Levy 2005 {published data only}
    1. Levy JH. Novel concepts in treatment and prevention of bleeding. IARS Review Course Lectures. International Anesthesia Research Society, 2005:43‐7.
Marti‐Carvajal 2011 {published data only}
    1. Marti‐Carvajal AJ, Simancas D, Cardona AF. Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia. Cochrane Database of Systematic Reviews 2011, Issue 6. [DOI: 10.1002/14651858.CD008562.pub2] - DOI - PubMed
McConnell 2011 {published data only}
    1. McConnell JS, Shewale S, Munro NA, Shah K, Deakin AH, Kinninmonth AWG. Reduction of blood loss in primary hip arthroplasty with tranexamic acid or fibrin spray. Acta Orthopaedica 2011;82(6):660‐3. - PMC - PubMed
McConnell 2012 {published data only}
    1. McConnell JS, Shewale S, Munro NA, Shah K, Deakin AH, Kinninmonth AWG. Reducing blood loss in primary knee arthroplasty: a prospective randomised controlled trial of tranexamic acid and fibrin spray. Knee 2012;19(4):295‐8. - PubMed
Mevio 1983 {published data only}
    1. Mevio E, Santarelli P. Tranexamic acid in prevention of oropharyngeal radiomucositis [L'acido tranexamico nella prevenzione delle radiomucositi a livello oro‐faringeo]. La Radiologia Medica 1983;69:325‐8. - PubMed
Movafegh 2011 {published data only}
    1. Movafegh A, Eslamian L, Dorabadi A. Effects of intravenous tranexamic acid administration on blood loss during and after cesarian delivery. International Journal of Gynecology and Obstetrics 2011;115:224‐6. - PubMed
NCT01980355 {published data only}
    1. Chung M. TXA study in major oncologic surgery. ClinicalTrials.gov November 4 2013, update January 21 2015; Vol. [Accessed August 12th 2015].
Rathi 2015 {published data only}
    1. Rathi NK, Tanner AR, Dinh A, Dong W, Feng L, Ensor J, et al. Low‐, medium‐ and high‐dose steroids with or without aminocaproic acid in adult hematopoietic SCT patients with diffuse alveolar hemorrhage. Bone Marrow Transplantation 2015;50:420‐6. - PubMed
Rickles 2007 {published data only}
    1. Rickles FR, Falanga A, Montesinos P, Sanz MA, Brenner B, Barbui T. Bleeding and thrombosis in acute leukemia: what does the future of therapy look like?. Thrombosis Research 2007;120(2):99‐106. - PubMed
Sanz 2010 {published data only}
    1. Sanz MA, Montesinos P. Open issues on bleeding and thrombosis in acute promyelocytic leukemia. Thrombosis Research 2010;125(2):51‐4. - PubMed
Schwartz 1986 {published data only}
    1. Schwartz BS, Williams EC, Conlan MG, Mosher DF. Epsilon‐aminocaproic acid in the treatment of patients with acute promyelocytic leukaemia and acquired alpha‐2‐plasmin inhibitor deficiency. Annals of Internal Medicine 1986;105:873‐7. - PubMed
Wassenaar 2008 {published data only}
    1. Wassenaar T, Black J, Kahl B, Schwartz B, Longo W, Mosher D, et al. Acute promyelocytic leukemia and acquired alpha‐2‐plasmin inhibitor deficiency: a retrospective look at the use of epsilon‐aminocaproic acid (Amicar) in 30 patients. Hematological Oncology 2008;26:241‐6. - PMC - PubMed
Yang 2001 {published data only}
    1. Yang H, Zheng S, Shi C. Clinical study on the efficacy of tranexamic acid in reducing postpartum blood loss: a randomized, comparative, multicenter trial. Chinese Journal of Obstetrics and Gynecology 2001;36(10):590‐2. - PubMed

References to ongoing studies

A‐TREAT 2015 {published data only}
    1. NCT02578901. American Trial Using Tranexamic Acid in Thrombocytopenia (A‐TREAT). ClinicalTrials.gov 15 October 2015 [Accessed 09 March 2016].
PROBLEMA 2014 {published data only}
    1. NCT02074436. PRevention Of BLeeding in hEmatological Malignancies With Antifibrinolytic (Epsilon Aminocaproic Acid) (PROBLEMA). ClinicalTrials.gov 26 February 2014, last updated 31 May 31 2015; Vol. [Accessed 12/08/2015].
TREATT 2015 {published data only}
    1. ISRCTN 73545489. A double blind, randomised controlled TRial EvaluAting the safety and efficacy of Tranexamic acid in patients with haematological malignancies with severe Thrombocytopenia (TREATT). ISRCTN registry 25th March 2015 [Accessed 12 August 2015].

Additional references

BCSH 2003
    1. British Committee for Standards in Haematology. Guidelines for the use of platelet transfusions. British Journal of Haematology 2003;122(1):10‐23. - PubMed
Bolton‐Maggs 2012
    1. Bolton‐Maggs PHB (editor) and Cohen H on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group. The 2011 Annual SHOT Report. Serious Hazards of Transfusion (SHOT), 2012.
Cameron 2007
    1. Cameron B, Rock G, Olberg B, Neurath D. Evaluation of platelet transfusion triggers in a tertiary‐care hospital. Transfusion 2007;47(2):206‐11. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Faught 1998
    1. Faught C, Wells P, Fergusson D, Laupacis A. Adverse effects of methods for minimizing perioperative allogeneic transfusion: a critical review of the literature. Transfusion Medicine Reviews 1998;12(3):206‐25. - PubMed
Fergusson 2008
    1. Fergusson DA, Hebert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, et al. A comparison of aprotinin and lysine analogues in high‐risk cardiac surgery. New England Journal of Medicine 2008;358(22):2319‐31. - PubMed
Franchini 2010
    1. Franchini M, Dario Di Minno MN, Coppola A. Disseminated intravascular coagulation in hematologic malignancies. Seminars in Thrombosis and Haemostasis 2010;36(4):388‐403. - PubMed
Friedmann 2002
    1. Friedmann AM, Sengul H, Lehmann H, Schwartz C, Goodman S. Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylactic platelet transfusions. Transfusion Medicine Reviews 2002;16(1):34‐45. - PubMed
Greeno 2007
    1. Greeno E, McCullough J, Weisdorf D. Platelet utilisation and the transfusion trigger: a prospective analysis. Transfusion 2007;72(2):201‐5. - PubMed
Guerriero 2011
    1. Guerriero C, Cairns J, Perel P, Shakur H, Roberts I. Cost‐effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH‐2 trial. PLoS One 2011;6(5):e18987. - PMC - PubMed
Gurusamy 2011
    1. Gurusamy KS, Pissanou T, Pikhart H, Vaughan J, Burroughs AK, Davidson BR. Methods to decrease blood loss and transfusion requirements for liver transplantation. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD009052.pub2] - DOI - PMC - PubMed
Heddle 2009
    1. Heddle NM, Webbert K. Chapter 6: Investigation of acute transfusion reactions. In: Murphy MF, Pamphilion DH editor(s). Practical Transfusion Medicine. 3rd Edition. Blackwell, 2009:63‐89.
Henry 2011
    1. Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, et al. Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD001886.pub4] - DOI - PubMed
Higgins 2011a
    1. Higgins JPT, Deeks JJ (editors). Chapter 7: Selecting studies and collecting data. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011b
    1. Higgins JPT, Deeks JJ, Altman DG (editors). Chapter 16: Special topics in Statistics. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011c
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Ker 2012
    1. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta‐analysis. BMJ 2012;344:e3054. [PUBMED: 22611164] - PMC - PubMed
Khorana 2006
    1. Khorana AA, Francis CW, Culakova E, Fisher RI, Kuderer NM, Lyman GH. Thromboembolism in hospitalized neutropenic cancer patients. Journal of Clinical Oncology 2006;24(3):484‐90. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Llewelyn 2009
    1. Llewelyn CA, Wells AW, Amin M, Casbard A, Johnson A J, Ballard S, et al. The EASTR study: a new approach to determine the reasons for transfusion in epidemiological studies. Transfusion Medicine 2009;19(2):89‐98. - PubMed
Lozano 2013
    1. Lozano M, Sweeney JD. Avoiding platelet transfusions. In: Sweeney J, Lozano M editor(s). Platelet Transfusion Therapy. Bethesda, Maryland: AABB Press, 2013:567‐89.
Martin 2011
    1. Martin K, Gertler R, Sterner A, MacGuill M, Schreiber C, Horer J, et al. Comparison of blood‐sparing efficacy of epsilon‐aminocaproic acid and tranexamic acid in newborns undergoing cardiac surgery. The Thoracic and Cardiovascular Surgeon 2011;59(5):276‐80. - PubMed
Martin‐Hirsch 2010
    1. Martin‐Hirsch PPL, Keep SL, Bryant A. Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews 2010, Issue 6. [DOI: 10.1002/14651858.CD001421.pub2] - DOI - PMC - PubMed
Novikova 2011
    1. Novikova N, Hofmeyr GJ. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD007872.pub2] - DOI - PubMed
Okamoto 1997
    1. Okamoto S, Hijikata‐Okunomiya A, Wanaka K, Okada Y, Okamoto U. Enzyme‐controlling medicines: introduction. Seminars in Thrombosis and Hemostasis 1997;23(6):493‐501. - PubMed
Pendry 2011
    1. Pendry K, Davies T. An audit of the use and wastage in the North West of England and North Wales ‐ where have all the platelets gone?. Blood and Transfusion Matters 2011;34:17‐9.
Pogue 1997
    1. Pogue JM, Yusuf S. Cumulating evidence from randomized trials: utilizing sequential monitoring boundaries for cumulative meta‐analysis. Controlled Clinical Trials 1997;18(6):580‐93. - PubMed
Popovsky 1985
    1. Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion‐related acute lung injury. Transfusion 1985;25(6):573‐7. - PubMed
Prentice 1980
    1. Prentice CR. Basis of antifibrinolytic therapy. Journal of Clinical Pathology Supplement 1980;14:35‐40. - PMC - PubMed
Roberts 2011
    1. Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH‐2 randomised controlled trial. Lancet 2011;377(9771):1096‐101, 1101.e1‐2. - PubMed
Roos 2008
    1. Roos YB, Rinkel GJE, Vermeulen M, Algra A, Gijn J. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD001245] - DOI - PubMed
Sawamura 2009
    1. Sawamura A, Hayakawa M, Gando S, Kubota N, Sugano M, Wada T, et al. Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thrombosis Research 2009;124(5):608‐13. - PubMed
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Shakur 2010
    1. Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH‐2): a randomised, placebo‐controlled trial. Lancet 2010;376(9734):23‐32. - PubMed
Slichter 2005
    1. Slichter SJ, Davis K, Enright H, Braine H, Gernsheimer T, Kao KJ, et al. Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood 2005;105(10):4106‐14. - PMC - PubMed
Slichter 2010
    1. Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. New England Journal of Medicine 2010;362(7):600‐13. - PMC - PubMed
Sterne 2011
    1. Sterne JAC, Egger M, Moher D (editors). Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Intervention. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Tzortzopoulou 2008
    1. Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD006883.pub2] - DOI - PubMed

References to other published versions of this review

Wardrop 2012
    1. Wardrop D, Estcourt L, Doree C, Hopewell S, Stanworth S, Murphy MF. Anti‐fibrinolytics (lysine analogues) for the prevention of bleeding in patients with haematological disorders. Cochrane Database of Systematic Reviews 2012, Issue 3. [DOI: 10.1002/14651858.CD009733] - DOI - PubMed
Wardrop 2013
    1. Wardrop D, Estcourt LJ, Doree C, Hopewell S, Stanworth S, Murphy MF. Antifibrinolytics (lysine analogues) for the prevention of bleeding in patients with haematological disorders. Cochrane Database of Systematic Reviews 2013, Issue 7. [DOI: 10.1002/14651858.CD009733.pub2] - DOI - PubMed

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