Estcourt, L.J., Desborough, M., Brunskill, S.J., Doree, C., Hopewell, S., Murphy, M.F., & Stanworth, S.J. (2016). Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders. Cochrane Database of Systematic Reviews, 3, CD009733.

DOI Link

Purpose

STUDY PURPOSE: To examine the effectiveness of lysine analogues in the prevention of bleeding related to hematological disorders

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, the Transfusion Evidence Library, and ongoing trial databases
 
INCLUSION CRITERIA: Patients with hematological disorders, who routinely require prophylactic platelet transfusions. Use of lysine analogues tranexamic acid (TXA) and epsilon aminocaproic acid (EACA)
 
EXCLUSION CRITERIA: None noted

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Four studies were used from a prior review, and 2,219 other studies were found. After removing duplicates, 322 were left.  
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: None found

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 3 (7 total, but 3 had not been completed and were not included and one was excluded because of flaws in the study)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 86
  • KEY SAMPLE CHARACTERISTICS: Adults with acute leukemia receiving chemotherapy

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Three studies located have not been concluded but may show promise in future analysis. However, the three studies included in the update of this review compared the lysine analogue to placebo. No significant results related to the risk of bleeding were found. All the studies reported a decrease in platelet transfusions given, but no meta-analysis could be performed.

Conclusions

No certain findings existed following this systematic review. Whether TXA or EACA decrease the risk of bleeding or the use of platelet transfusions, or increase the risk of developing a clot, is unclear. Whether they cause adverse events is also unclear.

Limitations

  • Limited number of studies included
  • Low sample sizes
  • Risk of bias because of lack of study methodology reporting
  • Low quality evidence

Nursing Implications

At this time, not enough evidence supports the use of TXA and EACA in adult patients with acute leukemia receiving chemotherapy.

Legacy ID

6337