OBJECTIVE: To review randomized trials involving the use of systemic hemost
atic medications for reducing surgical blood loss.
DATA SOURCES: Articles were obtained through searches of MEDLINE (1966-Sept
ember 2000). The bibliographies of retrieved publications were reviewed for
additional references.
STUDY SELECTION: All randomized studies and pharmacoeconomic evaluations th
at involved medications used for systemic asis in the perioperative period
were included.
DATA EXTRACTION: Randomized studies involving conjugated estrogens, aminoca
proic acid, tranexamic acid, desmopressin, and aprotinin for systemic hemos
tasis were extracted. Studies of proton-pump inhibitors for upper gastroint
estinal bleeding and octreotide for variceal bleeding were excluded, as wer
e trials involving the use of any hemostatic agent for cardiovascular surge
ry. The primary outcome under review was a reduction in bleeding as defined
by reduced transfusion requirements.
DATA SYNTHESIS: There is limited efficacy and toxicity information concerni
ng the use of conjugated estrogens for reducing surgery-related bleeding. S
imilarly, there are a limited number of randomized studies involving aminoc
aproic acid and tranexamic acid, and with the exception of tranexamic acid
for reducing transfusion requirements with knee surgery, the study results
are either conflicting or negative. For desmopressin, evidence from a subst
antial number of randomized trials documents its lack of efficacy. Aprotini
n; Eras reduced bleeding and transfusion requirements in a number of random
ized studies involving patients undergoing orthopedic surgery, but cost-eff
ectiveness studies are needed to better define its therapeutic role. Trials
of aprotinin during hepatic surgery have yielded conflicting results.
CONCLUSIONS: Most hemostatic medications used for reducing surgery-related
bleeding have limited or contradictory evidence of efficacy.