This document discusses various pharmacological measures for reducing blood product use. It describes antifibrinolytic drugs like tranexamic acid and aprotinin which inhibit fibrinolysis. Studies found tranexamic acid reduced the need for blood transfusions in trauma and surgery without increasing risks of thrombosis. Vasopressin may also help by reducing vasodilation and hypotension after cardiopulmonary bypass. While antifibrinolytics can lower transfusion needs, their effects on outcomes like mortality and thrombosis are uncertain. Further research is still needed on their risks and benefits in different clinical contexts.

1. MEDIDAS
FARMACOLÓGICAS
PARA AHORRO DE
HEMODERIVADOS
NICOLÁS MARTINEZ CALLE
SERVICIO DE HEMATOLOGÍA
CLÍNICA UNIVERSIDAD DE NAVARRA
NMARTINEZC@UNAV.ES

2. GRUPOS FARMACOLOGICOS

3. Antifibrinolíticos
EACA
Tranexámico
Aprotinina
Retirada en 2008 por
complicaciones
cardiovasculares

4. ACTIVIDAD FIBRINOLITICA
TEJIDOS
• Utero
• Suprarrenales
• Ganglios
• Prostata
• Tiroides
• Pulmon
• Ovarios
FLUIDOS
• Leche materna
• Lagrimas
• Saliva
• Bilis

5. MECANISMO
HIPERFIBRINOLISIS
Brohi et al. Curr Op Crit Care, 2007

6. HIPERFIBRINOLISIS
• DIFERIDA EN EL TIEMPO
• DIAGNOSTICADA TARDE

7. FIBRINOLISIS EN H. MASIVA
Brohi K, Cohen MJ, Ganter MT, Schultz
MJ, Levi M, Mackersie RC, Pittet JF. Acute
coagulopathy of trauma: hypoperfusion
induces systemic anticoagulation and
hyperfibrinolysis. J Trauma.
2008;64:1211Y1217;
discussion 1217.
Cotton et al. J Trauma Acute Care Surg, 2012

8. ACIDO TRANEXAMICO

10. ESTUDIO CRASH-2

11. GUIAS
BCSH

12. ANTIFIBRINOLITICOS EN
HEMORRAGIA NO TRAUMATICA
Kozek-Langenecker et al. Eur J Anaesthesiol 2013

13. CIRUGIA OBSTETRICA

14. TRANEXAMICO EN
CIRUGIA DE CADERA
Wang et al. Thromb Res 2014

15. ANTIBRINOLITICOS
EN CX CARDIACA
Reoperaciones
• Totales: OR 0.49
• Sangrado OR 0.26
• Taponamiento OR 0.61
Tasa transfusion
• 37.9% vs 54.7%
Mortalidad
• OR 0.79 (NS)
Días UCI
• 28 vs 34
Convulsiones
• OR 7.62
Myles et al. NEJM, 2017

16. ANTIFIBRINOLISIS EN
CIRUGIA PROSTATICA
Crescenti et al. BMJ, 2011

17. RIESGOS ANTIFIBRINOLISIS
INSUFICIENCIA RENAL
• 4% de los pacientes,
no diferencias.
CONVULSIONES (0.9%):Antagonista GABAA
Sharma et al. Anaesth 2014

18. RIESGO TROMBOTICO
N=2000
Gillete et al. Clin Orthop Rel Res, 2013

19. We identified five trials involving 372 people that met the
inclusion criteria. Three trials (260 patients) contributed data
to the analyses. The effect of tranexamic acid on mortality
(RR 1.01; 95% CI 0.14 to 7.3) was uncertain. However,
tranexamic acid reduced the probability of receiving a blood
transfusion by 30% although the estimate was imprecise (RR
0.70; 95% CI 0.52 to 0.94). The effects on deep venous
thrombosis (RR 2.29; 95% CI 0.68 to 7.66) and stroke (RR
2.79; 95% CI 0.12 to 67.10) were uncertain. There were no
events of pulmonary embolism or myocardial infarction.
None of the trials reported units of blood transfused,
reoperation or seizure outcomes.

20. VASOPRESINA (DDAVP)
• Numerosos estudios animales en shock hemorrágico
• Estudios en Shock séptico en humanos

21. VASOPRESINA
Nonetheless, the consequences of vasodilation after CBP were diminished by
prophylactic AVP administration in our patients at risk for this complication.
Vasopressin significantly reduced the number of hypotensive episodes, the
peak norepinephrine dose used to maintain arterial pressure off CPB, and
the duration of catecholamine vasopressor use compared with the placebo
group. These results were associated with earlier extubation and a shorter
ICU length of stay for the vasopressin group.

22. CASOS PARTICULARES
Terlipresina: Sangrado variceal (Am J Gastroenterol, 2009)