Download Transmine 1. Tranexamic acid (Tansamine) (antifibrinolytic agent

Transmine
1. Tranexamic acid (Tansamine)
(antifibrinolytic agent)
Transamine
Transamine
2. Transmine
0.5
1g(
10 15mg/kg
2-3
)
1-1.5g
3-4
LD50(50%
)
18
transmine
dose
1-2
loading
2g
Transmine
3. Transamine
Transamine
4.
Transamine
Transamine
Transmine
Tranexamic acid
Med-line
Tranexamic acid, hemorrhage, thrombosis
key word
1. Acta-Orthop-Scand. 2000 Jun; 71(3): 250-4
Tranexamic acid, given at the end of the operation, does not reduce postoperative
blood loss in hip arthroplasty.
Benoni,-G; Lethagen,-S; Nilsson,-P; Fredin,-H
--- We performed a randomized double-blind study on the effect of tranexamic
acid on postoperative blood loss and blood transfusions in 39 primary THR
operations. Tranexamic acid was given at the end of the operation and 3 hours
later. Ultrasound examination 1 week later was performed to measure the
occurrence of deep hematomas. In contrast to previous findings in knee
arthroplasty, the administration of tranexamic acid failed to give a significant
reduction in the postoperative blood loss. This lack of effect was possibly related
to the fact that the drug was administered too late. In 11 of the 20 patients
receiving tranexamic acid, blood transfusion was not necessary, this being the
case in 4/19 in the placebo group (p = 0.05). The occurrence of postoperative
deep venous thromboses was similar in the tranexamic acid and placebo groups.
2. Anesth.Analg.2000 Nov;91(5):1124-30
Tranexamic acid reduces blood loss in total hip replacement surgery
Ekback,G.; Axelsson,K.; Ryttberg,L.; Edlund,B.; Kjellberg,J.; Weckstrom,J.;
Carlsson,O.; Schott,U.
--- Intraoperatively administered, tranexamic acid (TA) does not reduce
bleeding in total hip replacement (THR). Therefore, its prophylactic use was
attempted in the present study because this has been shown to be more
effective in cardiac surgery. We investigated 40 patients undergoing THR in
a prospective, randomized, double-blinded study. Twenty patients received
TA given in two bolus doses of 10 mg/kg each, the first just before surgical
incision and the second 3 h later. In addition, a continuous infusion of TA,
1.0 mg. kg(-1). h(-1) for 10 h, was given after the first bolus dose. The
remaining 20 patients formed a control group. Both groups used preoperative
autologous blood donation and intraoperative autotransfusion. Intraoperative
bleeding was significantly less (P: = 0.001) in the TA group compared with
the control group (630 +/- 220 mL vs 850 +/- 260 mL). Postoperative
drainage bleeding was correspondingly less (P: = 0.001) (520 +/- 280 vs 920
+/- 410 mL). Up to 10 h postoperatively, plasma D-dimer concentration was
halved in the TA group compared with the control group. One patient in each
group had an ultrasound-verified late deep vein thrombosis. In conclusion,
we found TA, administrated before surgical incision, to be efficient in
reducing bleeding during THR. Implications: In a prospective,
double-blinded study of 40 patients undergoing total hip replacement, the
preoperative administration of tranexamic acid reduced bleeding by 35%,
probably by decreasing induced fibrinolysis. Whether tranexamic acid
therapy can replace predonation of autologous blood or intraoperative
autotransfusion requires further study
3. Anesth.Analg.2000;92:29-34.
Tranexamic acid reduces red cell transfusion better than
epsilon-aminocaproic acid or placebo in liver transplantation
Dalmau,A.; Sabate,A.; Acosta,F.; Garcia-Huete,L.; Koo,M.; Sansano,T.;
Rafecas,A.; Figueras,J.; Jaurrieta,E.; Parrilla,P.
--- We evaluated the efficacy of the prophylactic administration of
epsilon-aminocaproic acid and tranexamic acid for reducing blood product
requirements in orthotopic liver transplantation (OLT) in a prospective,
double-blinded study performed in 132 consecutive patients. Patients were
randomized to three groups and given one of three drugs prophylactically:
tranexamic acid, 10 mg. kg(-1). h(-1); epsilon-aminocaproic acid, 16 mg.
kg(-1). h(-1), and placebo (isotonic saline). Perioperative management was
standardized. Coagulation tests, thromboelastogram, and blood requirements
were recorded during OLT and in the first 24 h. There were no differences in
diagnosis, Child score, or preoperative coagulation tests among groups.
Administration of packed red blood cells was significantly reduced (P =
0.023) during OLT in the tranexamic acid group, but not in the
epsilon-aminocaproic acid group. There were no differences in transfusion
requirements after OLT. Thromboembolic events, reoperations, and mortality
were similar in the three groups. Prophylactic administration of tranexamic
acid, but not epsilon-aminocaproic acid, significantly reduces total packed
red blood cell usage during OLT. IMPLICATIONS: In a randomized study
of 132 consecutive patients undergoing liver transplantation, we found that
tranexamic acid, but not epsilon-aminocaproic acid, reduced intraoperative
total packed red blood cell transfusion
4. Anesthesiology 2000;92:674-82.
Comparison of blood-conservation strategies in cardiac surgery patients at
high risk for bleeding
Nuttall,G.A.; Oliver,W.C.; Ereth,M.H.; Santrach,P.J.; Bryant,S.C.;
Orszulak,T.A.; Schaff,H.V.
--- BACKGROUND: Aprotinin and tranexamic acid are routinely used to
reduce bleeding in cardiac surgery. There is a large difference in agent price
and perhaps in efficacy. METHODS: In a prospective, randomized, partially
blinded study, 168 cardiac surgery patients at high risk for bleeding received
either a full-dose aprotinin infusion, tranexamic acid (10-mg/kg load, 1-mg x
kg(-1) x h(-1) infusion), tranexamic acid with pre-cardiopulmonary bypass
autologous whole-blood collection (12.5% blood volume) and reinfusion
after cardiopulmonary bypass (combined therapy), or saline infusion
(placebo group). RESULTS: There were complete data in 160 patients. The
aprotinin (n = 40) and combined therapy (n = 32) groups (data are median
[range]) had similar reductions in blood loss in the first 4 h in the intensive
care unit (225 [40-761] and 163 [25-760] ml, respectively; P = 0.014),
erythrocyte transfusion requirements in the first 24 h in the intensive care
unit (0 [0-3] and 0 [0-3] U, respectively; P = 0.004), and durations of time
from end of cardiopulmonary bypass to discharge from the operating room
(92 [57-215] and 94 [37, 186] min, respectively; P = 0.01) compared with the
placebo group (n = 43). Ten patients in the combined therapy group (30.3%)
required transfusion of the autologous blood during cardiopulmonary bypass
for anemia. CONCLUSIONS: The combination therapy of tranexamic acid
and intraoperative autologous blood collection provided similar reduction in
blood loss and transfusion requirements as aprotinin. Cost analyses revealed
that combined therapy and tranexamic acid therapy were the least costly
therapies
5. J.Thorac.Cardiovasc.Surg. 2000;119:575-80.
Topical use of tranexamic acid in coronary artery bypass operations: a
double-blind, prospective, randomized, placebo-controlled study
De Bonis,M.; Cavaliere,F.; Alessandrini,F.; Lapenna,E.; Santarelli,F.;
Moscato,U.; Schiavello,R.; Possati,G.F.
--- OBJECTIVES: We sought to investigate the effect of topical application
of tranexamic acid into the pericardial cavity in reducing postoperative blood
loss in coronary artery surgery. METHODS: A prospective, randomized,
double-blind investigation with parallel groups was performed. Forty
consecutive patients undergoing primary coronary surgery were randomly
assigned to group 1 (tranexamic acid group) or group 2 (placebo group).
Tranexamic acid (1 g in 100 mL of saline solution) or placebo was poured
into the pericardial cavity and over the mediastinal tissues before sternal
closure. The drainage of mediastinal blood was measured hourly. RESULTS:
Chest tube drainage in the first 24 hours was 485 +/- 166 mL in the
tranexamic acid group and 641 +/- 184 mL in the placebo group (P =.01).
Total postoperative blood loss was 573 +/- 164 mL and 739 +/- 228 mL,
respectively (P =.01). The use of banked donor blood products was not
significantly different between the two groups. Tranexamic acid could not be
detected in any of the blood samples blindly collected from 24 patients to
verify whether any systemic absorption of the drug occurred. There were no
deaths in either group. None of the patients required reoperation for bleeding.
CONCLUSIONS: Topical application of tranexamic acid into the pericardial
cavity after cardiopulmonary bypass in patients undergoing primary coronary
bypass operations significantly reduces postoperative bleeding. Further
studies must be carried out to clarify whether a more pronounced effect on
both bleeding and blood products requirement might be seen in procedures
with a higher risk of bleeding
6. J.Thorac.Cardiovasc.Surg. 2002; 123(6):1084-91
Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: a
prospective, randomized, double-blind, placebo-controlled study
Casati,V.; Sandrelli,L.; Speziali,G.; Calori,G.; Grasso,M.A.; Spagnolo,S.
--- OBJECTIVE: We studied the hemostatic effects of tranexamic acid in
patients undergoing elective surgery involving the thoracic aorta.
METHODS: In a double-blind, randomized fashion, 60 consecutive patients
were assigned to two treatment groups: 30 patients (placebo group) received
infusion of saline solution, and 30 (treatment group) received tranexamic
acid (1 g before skin incision, an infusion of 400 mg/h during the operation,
and 500 mg in the pump priming). Perioperative bleeding was considered as
a primary outcome. Perioperative allogeneic transfusions, major thrombotic
complications (myocardial infarction, pulmonary embolism, renal
insufficiency), and surgical outcomes were also considered. RESULTS:
Patients treated with tranexamic acid showed significant reductions in
postoperative bleeding, both in terms of the amount collected during the first
4 postoperative hours (median 307 mL, interquartile range 253-361 mL in the
placebo group vs median 211 mL, interquartile range 108-252 mL in the
treatment group, P =.002) and in terms of total bleeding (median 722 mL,
interquartile range 574-952 mL in the placebo group vs median 411 mL,
interquartile range 313-804 mL in the treatment group, P =.04).
Consequently, the number of patients transfused differed significantly
between groups (21 patients [72.4%] in the placebo group vs 13 [44.8%] in
the treatment group, P =.033). Patients in the treatment group showed
significant reductions in the total amount for the entire group of packed red
cells transfused (13,500 mL in the treatment group vs 28,000 mL in the
placebo group, P =.012) and in the total amount of allogeneic transfusions
(23,400 mL in the treatment group vs 53,000 mL in the placebo group, P
=.024). No differences in perioperative thrombotic complications were found.
CONCLUSIONS: In this initial series of patients undergoing thoracic aortic
surgery, tranexamic acid appeared effective in reducing perioperative
bleeding, with a significant reduction in the need for allogeneic transfusions
and without any increased risk of thrombotic complications
7. Ann.Thorac.Surg. 2001; 71:1508-1511
Is tranexamic acid safe in patients undergoing coronary endarterectomy?
Ruel,M.A.; Wang,F.; Bourke,M.E.; Dupuis,J.Y.; Robblee,J.A.; Keon,W.J.;
Rubens,F.D.
--- BACKGROUND: Patients undergoing coronary endarterectomy during
coronary artery bypass grafting (CABG) are at increased risk of perioperative
myocardial infarction due to coronary intimal disruption. Data assessing the
safety of the antifibrinolytic drug tranexamic acid (TA) in patients
undergoing this procedure are lacking. METHODS: From September 1997 to
December 1999, 221 patients underwent nonemergency primary CABG with
endarterectomy of the right coronary artery alone in 149, the left anterior
descending in 35, or both right and left anterior descending in 27. TA was
administered intraoperatively to 87 patients (TA group: average total dose 62
+/- 4.4 mg/kg; range 20 to 109 mg/kg), and was not administered to 134
patients (No TA group). RESULTS: The patient characteristics of the 2
groups were similar. In-hospital mortality consisted of 2 patients in the TA
group and 4 patients in the No TA group. Perioperative myocardial infarction
rates were 2% and 5% in the TA and No TA groups, respectively (p = 0.49).
The relative risk for any type of perioperative cardiac ischemic event in the
TA group versus the No TA group was 0.77 (95% CI; 0.4, 1.2). Patients in
the TA group had a significant reduction in postoperative chest tube drainage
(685 versus 894 mL in the TA versus No TA groups, respectively) and in the
use of fresh-frozen plasma (p = 0.03). CONCLUSIONS: These results
suggest that the clinical effectiveness of tranexamic acid in reducing
postoperative blood loss in patients undergoing coronary endarterectomy is
not associated with a higher incidence of myocardial ischemia-related
complications
8. Arch-Orthop-Trauma-Surg. 2000; 120(9): 518-20
Reduction of blood loss using tranexamic acid in total knee and hip
arthroplasties.
Ido,-K; Neo,-M; Asada,-Y; Kondo,-K; Morita,-T; Sakamoto,-T; Hayashi,-R;
Kuriyama,-S
--- There have been several attempts to reduce postoperative blood loss in
patients undergoing total arthroplasty. Benoni et al. reported the usefulness of
tranexamic acid in total knee arthroplasty (TKA). We investigated its effect
in TKA and total hip arthroplasty (THA). Blood loss was significantly
reduced in patients given tranexamic acid in both the TKA and THA groups,
and no severe complications, such as venous or pulmonary thrombosis, were
noted in any of the patients who received the agent. Administration of
tranexamic acid seems to be useful for reducing postoperative blood loss in
TKA and THA.
9. Anesthesiology. 2001 Jan; 94(1): 8-14
Tranexamic acid administration after cardiac surgery: a prospective,
randomized, double-blind, placebo-controlled study.
Casati,-V; Bellotti,-F; Gerli,-C; Franco,-A; Oppizzi,-M; Cossolini,-M;
Calori,-G; Benussi,-S; Alfieri,-O; Torri,-G
--- BACKGROUND: Many different doses and administration schemes have
been proposed for the use of the antifibrinolytic drug tranexamic acid during
cardiac surgery. This study evaluated the effects of the treatment using
tranexamic acid during the intraoperative period only and compared the
results with the effects of the treatment continued into the postoperative
period. METHODS: Patients undergoing elective cardiac surgery with use of
cardiopulmonary bypass (N = 510) were treated intraoperatively with
tranexamic acid and then were randomized in a double-blind fashion to one
of three postoperative treatment groups: group A: 169 patients, infusion of
saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg x
kg(-1) x h(-1) for 12 h; group C: 170 patients, infusion of tranexamic acid, 2
mg x kg(-1) x h(-1) for 12 h. Bleeding was considered to be a primary
outcome variable. Hematologic data, allogeneic transfusions, thrombotic
complications, intubation time, and intensive care unit and hospital stay
duration also were evaluated. RESULTS: No differences were found among
groups regarding postoperative bleeding and outcomes; however, the group
treated with 1 mg x kg(-1) x h(-1) tranexamic acid required more units of
packed red blood cells because of a significantly lower basal value of
hematocrit, as shown by multivariate analysis. CONCLUSIONS:
Prolongation of treatment with tranexamic acid after cardiac surgery is not
advantageous with respect to intraoperative administration alone in reducing
bleeding and number of allogeneic transfusions. Although the prevalence of
postoperative complications was similar among groups, there is an increased
risk of procoagulant response because of antifibrinolytic treatment. Therefore,
the use of tranexamic acid during the postoperative period should be limited
to patients with excessive bleeding as a result of primary fibrinolysis.
10. Int-J-Cardiol. 2002 Jun; 83(3): 267-8
Acute myocardial infarction after oral tranexamic acid treatment initiation.
Mekontso-Dessap,-A; Collet,-J-P; Lebrun-Vignes,-B; Soubrie,-C; Thomas,-D;
Montalescot,-G
--11. Eur-J-Haematol. 2002 May; 68(5): 307-9
Pulmonary embolism associated with tranexamic acid in severe acquired
haemophilia.
Taparia,-M; Cordingley,-F-T; Leahy,-M-F
--- Tranexamic acid (an antifibrinolytic agent) is of proven benefit in the
treatment of bleeding in patients with congenital and acquired coagulation
disorders. We report the case of a patient with an acquired Factor VIII
inhibitor, who was on a prophylactic dose of tranexamic acid because of
recurrent bleeding episodes and developed a pulmonary embolism. Although
studies using tranexamic acid have not shown a definite increased risk for the
development of venous thrombosis, this is the likely cause of the pulmonary
embolism in this patient.
12. Gut. 2001 Sep; 49(3): 372-9
Drug treatments in upper gastrointestinal bleeding: value of endoscopic
findings as surrogate end points.
Hawkey,-G-M; Cole,-A-T; McIntyre,-A-S; Long,-R-G; Hawkey,-C-J
--- INTRODUCTION: Pharmacotherapy for upper gastrointestinal bleeding
has been difficult to evaluate because clinical end points are infrequent and
affected by other factors. AIMS: To evaluate whether blood in the stomach at
endoscopy reflected severity of bleeding, predicted clinical outcomes, and
could be altered by therapeutic agents. METHODS: We studied 414
consecutive admissions with suspected upper gastrointestinal bleeding.
Patients were randomised to receive lansoprazole 60 mg followed by 30 mg
four times daily, tranexamic acid 2 g followed by 1 g four times daily, both
drugs, or placebo for four days, until discharge or a clinical end point
occurred. Logistic regression analysis was used to determine predictors of
endoscopic changes and clinical outcomes, and to investigate the effects of
drug treatments on blood in the stomach. RESULTS: Of 414 patients with
suspected upper gastrointestinal bleeding, 379 were endoscoped. Upper
gastrointestinal bleeding was confirmed in 316. Sixteen required surgery
within 30 days and 16 died on the index admission. Trial treatments were
evaluable on a per protocol basis in 228 patients. The amount of blood in the
stomach was found to reflect initial risk, with significant associations with
high risk categorisation (odds ratio 3.7 (95% confidence interval 1.5-9.4) for
more than a trace v none/trace), age (1.5 (1.1-1.9) per decade), and initial
pulse (1.02 (1.00-1.04) per beat), and to predict rebleeding (9.2 (4.6-18.7))
and surgery (8.2 (2.9-22.9)). Other stigmata were less significant in these
respects. The amount of blood in the stomach at endoscopy was reduced
significantly by both lansoprazole (0.22 (0.07-0.63)) and tranexamic acid
(0.27 (0.09-0.81)), although there was no evidence of synergy.
CONCLUSIONS: Blood in the stomach reflects clinical features in patients
with acute upper gastrointestinal bleeding and is reduced by treatment with
lansoprazole and tranexamic acid.
13. Transfusion. 1991 May; 31(4): 345-8
Lack of efficacy of tranexamic acid in thrombocytopenic bleeding.
Fricke,-W; Alling,-D; Kimball,-J; Griffith,-P; Klein,-H
--- A controlled, randomized, double-blind study was performed to assess the
effect of the oral antifibrinolytic agent tranexamic acid in patients with
amegakaryocytic thrombocytopenia as regards their need for platelet transfusions and
the number of bleeding episodes experienced. Each patient served as his or her own
control and received sequential, randomized courses of either tranexamic acid or an
identical placebo. The need for platelet transfusions due to bleeding and the total
number of bleeding episodes were compared for tranexamic acid and placebo courses.
Patients received platelet transfusions at the discretion of their personal physician and
kept detailed records of bleeding episodes. Of three patients who completed the full
study, none had a reduction in the need for platelet transfusions. Moreover, in the
eight patients who participated in the study, there was no reduction in number of
bleeding episodes during tranexamic acid treatment as compared to the number with
placebo. Our data indicate that the prophylactic administration of tranexamic acid
does not decrease dependence on platelet transfusions or decrease bleeding episodes
in patients with bleeding due to amegakaryocytic thrombocytopenia.
Transamine
Therapeutic use
i.v.
p.o.
2
1
3
1.5g (
3 4
)
Indicaitons:
1. Prevention of bleeding after surgery or trauma
a. tooth extraction in patients with hemophilia
trasamine 1 g tid x 5 days + factor VIII and IX
(Forbes CD et al. BMJ 1972; ii:311-3)
Hemophilia after extraction
Transamine 25mg/Kg B.W. p.o. qid x 5 days + Factor VIII or IX
(Sindet-Pedasen S et al. J oral Maxillofas Surg 1986; 44:703-7)
b. Cervical conization
14% rebleeding rate in open technique
1.5 g/day x 12 day, effective in double-blind studies
(Rybo G et al. Acta Obstet Gynalcol Sandi 1976; 51:347-50)
c. Bleeding in Tonsillectory and adenoidectomy
Double-blind trial
Transamine 10mg/Kg BW iv. significantly reduced rebleeding rate
(Verstraete M, et al. Acta Clin Belg 1977; 32:136-41)
d. Prostatic surgery
Reduced 50% of rebleeding after prostatectomy in control group to 24% in
treatment group
(Hedlung PO, Scand J Urol Nephrol 1969; 3:177-82,
Kaufmann J et al. Urologie 1969; 8:57-59)
e. Bleeding in ocular trauma
Precent rebleeding in the anterior chamber and vitreous body by historical
control studies
(Jerndal T, et al. Acta Ophthalmol 1976; 54:417-29.
Varnek L, et al. Acta ophthalmol 1980; 55:787-93)
f. Oral surgery in patients taking anticoagulatants
Operative area rinsed with 10ml 4.8% transamine and continue for 7 days 2
min rinse 10 ml transamine qid.
(sindet-Paterson S et al. New Engl J Med 1989; 320:840-3)
2. Prevention of rebleeding in subarachmoid hemorhage or ruptured aneurysms
Favor:
Roos Y et al Neurology 2000; 54:77-82.
Chandra B. Ann Neurol 1978; 3:502-4.
Fodstad H et al. Surg Neurol 1978; 10:9-15.
Maurice-Williams RC. BMJ 1978; 1:945-7
Vermeulen M et al. New Engl J Med 1984; 311:432-7.
Against:
Fodstad H et al. Neuro Surg 1981; 8:158-65.
Gelmers JH. Acta Neuro Chirug 1980; 52:45-50.
Kaste M. Stroke 1969; 10:519-22.
Van Rossum J et al. Ann Neurol 1977; 2:238-42.
Case report
in a hemodialysis patient. Nephrol Dialy Transpl 2000; 15:107-9.
3. Treatment of primary or IUD-induced menorrhagia
Total 1 1.5 g p.o reduce menorrhagia
(randomized trials. Callender ST et al. BMJ 1970; iv:214-6.
Venmylea J et al. Thromobosis et Haemorrhagica.1968; 20:583-7.
Review: Preutice A. BMJ 1999; 319:1343-5. )
4. Treatment of gastric and intestinal bleeding double-blind studies in diffuse
gastrititis or peptic ulcer
Barer D et al. New Engl J Med 1983; 308:1571-5.
Comack F et al. Lancet 1973; 1:1207-8.
Henry DA et al. BMJ 1989; 298:1142-6
Hawkey GM et al. (for rebleeding) Gut 2001; 49:372-9.
5. Prevention of sportaneous or postoperative corneal edema. Double blind study for
corneal edema after trabeculectomy or cataract operation: effective
Bramsen T et al. Acta Ophthamol 1978; 56:121-6.
Bramsen T. Acta Ophthelmol 1978; 56:998-1005.
6. Treatment of hereditary angioneurotic edema
Antosomal dominant disease due to C-1-esterase difficiency
Double-blind study
reduction of edema, long life used
Blomhe G. Acta Med Scand 1972; 192:293-8.
Scheiffer AL et al. New Engl J Med 1972; 287:452-4.
7. Treatment of non-heriditary angioedema
Caused by allergy or autoimmune disease
Double-blind study
long-term use effective
Munch EP et al. Allergy 1985; 40:92-7.
8. Prevention of bleeding in acute promyelocytic leukemia
Open study Schwartz BS et al. Ann Int Med 1986; 105:873-7.
Double-blind study Arrisati G et al. Lancet 1989; 11:122-4.
effective
9. Prevention of bleeding after cardio-pulmonary bypass or coronary and
arterectomy
Randomized trial
Ruel MA et al. Ann Thorac Surg 2001; 71:1508-11.
Karsi JM et al. J Thorac Cardiovasc Surg 1995; 110:835-48.
DeBonis M et al. J Thorac Candivas Surg 2000; 119:575-80.
Wong BI. Ann Thorac Surg 200; 69:808-16.
Castati V et al. prolonged use is not effective. Anesthesial 2001; 94:8-14.
10. Reduce bleeding in thoracic aortic surgery
Randomized study effective without increase thrombosis incidence
Casati V et al. J Throac Cardiovasc Surg 2002; 123:134-9.
11. Reduce red cell transfusion in liver transplantation effective, not increase arterial
thrombosis
Dalmau A. et al. Anesth Analg 2000; 91:129-34.
Dalmau A. et al. Anesth Analg 2001; 93:514.
Karkouti K. Anesth Analg 2000; 91:244.
Adverse reactions
Taparia M et al. Pulmonary embolism (iv. Transamine) Europ J Hematol 2002;
68:307.
Mekontso-Dessap A. et al. Acute MI, (p.o. transamine) Int J Cardiol 2002;
83:267-8.
Markivardt F. et al. Thrombosis Res 1976; 9:143-52.
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