Prescrire international
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Prescrire international · Jul 2013
Comparative StudyMidazolam oral transmucosal route. An alternative to rectal diazepam for some children.
In children, convulsive seizures lasting-more than 5 minutes constitute a life-threatening condition. Outside of the hospital setting, the treatment of choice is rectal diazepam. Midazolam, a fast-acting benzodiazepine, is now authorised for use in this setting, in the form of a solution for oral transmucosal route. ⋯ In early 2013, the usability of oral transmucosal versus rectal administration has not been compared prospectively in children with convulsive seizures. In practice, rectal diazepam is the drug of choice for paediatric convulsive seizures occurring outside the hospital setting. Midazolam oromucosal solution is an alternative for children over 6 months of age, especially when preparation or administration of the rectal diazepam dose poses a problem.
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Prescrire international · Jul 2013
ReviewTrauma and severe bleeding. Tranexamic acid within one hour to reduce mortality.
Tranexamic acid, an antifibrinolytic agent, reduces postoperative transfusion requirements but carries a poorly documented risk of thrombosis. Does tranexamic acid reduce mortality among victims of severe traumatic bleeding? To answer this question, we conducted a review of the literature, using the standard Prescrire methodology. The Crash-2 trial compared the impact of tranexamic acid versus placebo on overall mortality in 20 211 trauma victims with either severe bleeding or a high risk of severe bleeding. ⋯ Cases of thrombosis have also been reported. In 2011, the FDA warned of a risk of convulsions linked to high intravenous doses of this drug. In practice, intravenous tranexamic acid infusion has a favourable harm-benefit balance in patients with severe traumatic bleeding, especially when treatment begins less than 1 hour after injury, in which case it reduces mortality at 4 weeks.
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Tranexamic acid is an antifibrinolytic drug. It therefore reduces bleeding but, in certain situations, it may expose patients to a risk of thrombosis. It is used for the treatment of various types of bleeding, including menorrhagia, haematuria, certain surgical procedures and trauma. ⋯ Clinical trials conducted in serious haemorrhage or in patients undergoing surgery with a high risk of bleeding have not shown an increased risk of thrombosis with tranexamic acid. In practice, as of early 2013, the harm-benefit balance of tranexamic acidis favourable in severe traumatic bleeding. But when bleeding is not life-threatening, the thrombotic risk is too poorly documented to justify exposing patients to a plausible and inadequately evaluated risk.