RESUMO
BACKGROUND: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. METHODS: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator Both participants and study staff (site investigators and trial coordinating centre staff) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other AL analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.gov NCT00375258, and South African Clinical Trial Register DOH-27-0607-1919. RESULTS: 10096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10060 and 10067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14.5%] tranexamic acid group vs 1613 [160%] placebo group; relative risk 0.91, 95% CI 085-097; p = 00035). The risk of death due to bleeding was significantly reduced (489 [49%] vs 574 [5-7%]; relative risk 0-85, 95% CI 0.76-0.96; p = 0-0077). CONCLUSION: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients.
Assuntos
Antifibrinolíticos/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Hemorragia/tratamento farmacológico , Ácido Tranexâmico/uso terapêutico , Doenças Vasculares/prevenção & controle , Ferimentos e Lesões/complicações , Adulto , Causas de Morte , Distribuição de Qui-Quadrado , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Resultado do Tratamento , Doenças Vasculares/etiologiaRESUMO
Angioedema (AE) is a problem that all doctors inclusive of emergency room physicians and the otolaryngologists are often asked to treat. We present a six-year experience with this disorder. In this series, angiotensin-converting enzyme inhibitors (ACEIs) were related to 60% of admissions for angioedema. Lip and tongue swelling was the most common manifestation. The discontinuation of ACEI therapy and supportive management are the recommended approaches to treatment and prevention of unfavourable outcomes. The authors strongly recommend medic alert bracelets for all patients with this disorder. The use and side effects of ACEI therapy in our population which is predominantly of African descent warrants further investigations.
Assuntos
Angioedema/diagnóstico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioedema/induzido quimicamente , Pré-Escolar , Feminino , Hospitais Universitários , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Índias OcidentaisRESUMO
Angioedema (AE) is a problem that all doctors inclusive of emergency room physicians and the otolaryngologists are often asked to treat. We present a six-year experience with this disorder. In this series, angiotensin-converting enzyme inhibitors (ACEIs) were related to 60% of admissions for angioedema. Lip and tongue swelling was the most common manifestation. The discontinuation of ACEI therapy and supportive management are the recommended approaches to treatment and prevention of unfavourable outcomes. The authors strongly recommend medic alert bracelets for all patients with this disorder. The use and side effects of ACEI therapy in our population which is predominantly of African descent warrants further investigations.
El angioedema (AE) es un problema que todos los doctores incluyendo los médicos y otolaringólogos de las salas de emergencia se ven a menudo en la necesidad de tratar. A continuación presentamos una experiencia de seis años de enfrentamiento a esta afección. En esta serie, inhibidores de enzimas convertidoras de angiotensina (IECAs) se relacionaron con el 60% de los ingresos por angioedema. La hinchazón de los labios y la lengua fue la manifestación más común. La suspensión de la terapia con IECA y el tratamiento de apoyo son los métodos que se recomiendan para el tratamiento así como para la prevención de resultados desfavorables. Los autores recomiendan enfáticamente brazaletes de alerta médica para todos los pacientes con esta afección. El uso y los efectos colaterales de la terapia con IECA en nuestra población predominantemente de ascendencia africana merece investigación ulterior.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Angioedema , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Angioedema , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Hospitais Universitários , Jamaica , Índias OcidentaisRESUMO
The objective of the study was to examine the clinical and demographic features of patients with hip fractures presenting to the Accident and Emergency Department, the University Hospital of the West Indies (UHWI). The study involved all patients with hip fractures registered in the Trauma Registry at the UHWI between January 1, 1998 and December 31, 2001. They were assessed retrospectively for age, gender, associated extrinsic and intrinsic factors, cause of the fall, location when fracture occurred and the site of the femur that was fractured. One hundred and fifty-two persons were identified There were one hundred and eleven women and forty-one men. Seventy-eight per cent of the falls occurred in the over sixty-five-year age group. Ninety per cent of the patients had a fall associated with their fracture. Most of the falls occurred at the patients' homes. This study indicated that falling at home was the commonest associated factor for the occurrence of hip fractures and preventive measures may lead to reductions in the frequency of hip fractures seen in the emergency room.
Assuntos
Acidentes por Quedas/prevenção & controle , Fraturas do Quadril/etiologia , Acidentes Domésticos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The objective of the study was to examine the clinical and demographic features of patients with hip fractures presenting to the Accident and Emergency Department, the University Hospital of the West Indies (UHWI). The study involved all patients with hip fractures registered in the Trauma Registry at the UHWI between January 1, 1998 and December 31, 2001. They were assessed retrospectively for age, gender, associated extrinsic and intrinsic factors, cause of the fall, location when fracture occurred and the site of the femur that was fractured. One hundred and fifty-two persons were identified There were one hundred and eleven women and forty-one men. Seventy-eight per cent of the falls occurred in the over sixty-five-year age group. Ninety per cent of the patients had a fall associated with their fracture. Most of the falls occurred at the patients' homes. This study indicated that falling at home was the commonest associated factor for the occurrence of hip fractures and preventive measures may lead to reductions in the frequency of hip fractures seen in the emergency room