Avtor/Urednik     Vujkovac, Bojan; Lavre, Janez; Šabovič, Mišo
Naslov     Naše prve izkušnje s traneksamično kislino pri zdravljenju krvavitev pri dializnih bolnikih
Prevedeni naslov     Tranexamic acid in the treatment of bleeding in dialysis patients: our first experience
Tip     članek
Vir     Zdrav Vestn
Vol. in št.     Letnik 69, št. 5
Leto izdaje     2000
Obseg     str. 345-8
Jezik     slo
Abstrakt     Background. In patients with end stage renal disease, in the program of chronic hemodialysis, the bleeding is a common and potentially fatal complication arising from multiple acquired defects in hemostasis. The ability of tranexamic acid (TA), a potent antifibrinolytic agent, to stop serious bleeding in the dialysis patients was studied. Methods and results. During 57 months we treated 31 bleeding episodes (23 from upper gastrointestinal tract, 6 from lower gastrointestinal tract and 2 cerebral bleeding) in 16 dialysis patients. TA was used in the treatment of 6 episodes of serious bleeding from upper gastrointestinal, 4 episodes from lower gastrointestinal tract and two cases of cerebral bleeding. The dosage schedule for TA was 20 mg/kg body weight (mg/ kg) intravenously followed by 10 or 20 mg/kg/48 hours orally for at least four weeks. No significant decrease in haemoglobin concentrations was observed in all treated cases of the upper gastrointestinal bleeding, while in the group of patients who did not received TA recurrent bleeding occurred in 4 patients (23.5%). Hemorrhages from lower gastrointestinal tract (colonic angiodysplasia) were all successfully treated with TA, but bleeding reappeared few months after treatment. Two treated patients with cerebral hemorrhage were comatose (Glasgow Coma Scale 7 and 5). In the former case subdural and intracerebral hematomas resolved, whereas second patient died. Conclusions. Our first (nonrandomized) results suggest that TA could successfully stop the bleeding in dialysis patients. This remains to be confirmed in a further randomized study.
Izvleček     Izhodišča. Bolniki s končno odpovedjo ledvic, ki so v programu nadomestnega zdravljenja s hemodializo, imajo okvarjeno hemostazo in imajo zato pogosteje blage in hujše krvavitve. Proučevali smo učinkovitost traneksamične kisline (TA) pri zdravljenju hujših krvavitev pri dializnih bolnikih. TA izboljša delovanje okvarjene hemostaze tako, da ovira delovanje fibrinolitičnega sistema in izboljša delovanje trombocitov. Metode in rezultati. V obdobju 57 mesecev smo obravnavali 31 krvavitev (23 krvavitev iz zgornjih prebavil, 6 krvavitev iz spodnjih prebavil in 2 možganski krvavitvi) pri 16 dializnih bolnikih. S TA smo zdravili 6 krvavitev iz zgornjih prebavil, 4 krvavitve iz spodnjih prebavil in obe možganski krvavitvi. Bolniki so prejeli TA najprej v intravenskem bolusu 20 mg/kg telesne teže (mg/kg) in nato 10 ali 20 mg/kg/48 ur v obliki tablet še najmanj štiri tedne. V vseh primerih krvavitev iz zgornjih prebavil, zdravljenih s TA, nismo ugotovili nadaljevanja ali ponovitve krvavitve, medtem ko je v skupini bolnikov, ki niso bili zdravljeni s TA, v štirih primerih (23,5%) prišlo do ponovne krvavitve. Krvavitve iz spodnjih prebavil (angiodisplazije kolona) so se ob zdravljenju s TA ustavile, po ukinitvi zdravljenja pa so se ponovile. Oba bolnika s spontanimi možganskimi krvavitvami sta bila hudo prizadeta (Glasgowska lestvica kome 7 in 5). En bolnik je preživel, drugi je umrl. Zaključki. Naši prvi (nerandomizirani) rezultati nakazujejo, da je TA lahko učinkovita pri ustavljanju in preprečevanju krvavitev pri dializnih bolnikih. To predpostavko bo treba preveriti v večji, randomizirani raziskavi.
Deskriptorji     HEMODIALYSIS
HEMORRHAGE
TRANEXAMIC ACID