As Anesthesiologists, we are often are asked by our surgical colleagues to administer medication to treat excessive bleeding in the Operating Room. Although some agents may decrease blood loss in appropriate cases, it is important to understand the risks and limitations of each drug before it is given to a patient. It also is important to remind the surgeon to first rule out surgical bleeding; no drug is a substitute for surgical hemostasis and excellent surgical control of surgically induced hemorrhage.
The majority of these drugs are used perioperatively outside their FDA indications, and may have unknown safety issues. The search for ideal pharmacologic agents to reduce perioperative bleeding continues, and to date no single universal pharmacologic agent is available to solve the problem of excess peri- operative bleeding and transfusion. As anesthesiologists, we cannot alone realistically control issues that require surgical solutions and prevention.
Although PCCs and rFVIIa may be useful in certain settings, the best data exist for the lysine analog antifibrinolytics. Large safety trials and dose-finding studies for EACA and TA are war- ranted. TA has emerged as a potential lifesaving drug for trauma patients, and the CRASH-3 study may show similar results for patients with traumatic brain injury.
More careful surgical control of bleeding is needed rather than reliance on drugs to control bleeding. Also, as yet unknown side effects of these agents used to stimulate the coagulation cascade need to be further studied.
Thomas Peltzer, DMD, Dentist Anesthesiologist, www.ConnecticutSedationDentist.com, Plainville, CT 06062 860-747-5711
1. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. First of two parts—blood transfusion. N Engl J Med. 1999;340(6):438-447.
2. Pilbrant A, Schannong M, Vessman J. Pharmacokinetics and bio- availability of tranexamic acid. Eur J Clin Pharmacol. 1981;20(1): 65-72.
3. Soslau G, Horrow J, Brodsky I. Effect of tranexamic acid on plate- let ADP during extracorporeal circulation. Am J Hematol. 1991; 38(2):113-119.