Society for the Advancement of Patient Blood Management

View all recommendations from this society

July 1, 2021

Avoid bleeding and reduce transfusion risk by employing antifibrinolytic drugs.

Antifibrinolytic pharmacologic therapy has been shown to reduce blood loss and transfusion requirements in cardiovascular and non-cardiac surgeries. Early administration of tranexamic acid, specifically within three hours, in trauma and obstetric hemorrhage, significantly reduces mortality and bleeding. Numerous clinical trials utilizing antifibrinolytic therapy found reduced overall mortality and bleeding-related mortality without increased risk for thromboembolic events.

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How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient health care delivery and responsible use of resources.

A Task Force was appointed from within the BOD to draft the initial set of recommendations. Evidence-based recommendations were based on our society’s foundational pillars and structured around published SABM Standards. A critical feature was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were submitted to the membership for input via an email survey. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The BOD approved the materials prior to submission. Recent review with updates was undertaken by the SABM Educational Oversight Committee.

Working with this initiative, our selected recommendations and integrated materials were further honed based on subsequent campaign review. This list and supporting material resulted in a publication in a peer-reviewed journal in 2019. SABM will also develop monitors to assess the impact of the initiative for our members and hospital affiliates. We foresee this as a vehicle for outreach to other professional societies, health care providers and patients.

Sources

Henry DA, Carless PA, Moxey AJ et al. Anti-fibrinolytic drugs for reducing blood loss and the need for red blood cell transfusion during and after surgery. Cochrane Database Syst Rev 2011; (3): CD001886.

CRASH-2 Trial Collaborators Effects of tranexamic acid on death, vasoocclusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376(9734): 23-32.

WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. Lancet 2017; 389(10084): 2105-2116.

Taeuber I, Weibel S, Herrmann E et al. Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression. JAMA Surg 2021; doi: 10.1001/jamasurg.2021.0884.

Devereaux PJ, Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, Chan MTV, Borges FK, Martínez-Zapata MJ, Wang CY, Xavier D, Ofori SN, Wang MK, Efremov S, Landoni G, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Duceppe E, Ruetzler K, Parlow JL, Tandon V, Fleischmann E, Polanczyk CA, Lamy A, Astrakov SV, Rao M, Wu WKK, Bhatt K, de Nadal M, Likhvantsev VV, Paniagua P, Aguado HJ, Whitlock RP, McGillion MH, Prystajecky M, Vincent J, Eikelboom J, Copland I, Balasubramanian K, Turan A, Bangdiwala SI, Stillo D, Gross PL, Cafaro T, Alfonsi P, Roshanov PS, Belley-Côté EP, Spence J, Richards T, VanHelder T, McIntyre W, Guyatt G, Yusuf S, Leslie K; POISE-3 Investigators. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. N Engl J Med. 2022 May 26;386(21):1986-1997. doi: 10.1056/NEJMoa2201171. Epub 2022 Apr 2. PMID: 35363452.