関: antifibrinolytic、antifibrinolytic agent、antiplasmin、plasmin inhibitor

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/12/06 02:04:50」(JST)

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Antifibrinolytics are a class of medication that are inhibitors of fibrinolysis.^[1] Examples include aminocaproic acid (ε-aminocaproic acid) and tranexamic acid. These lysine-like drugs interfere with the formation of the fibrinolytic enzyme plasmin from its precursor plasminogen by plasminogen activators (primarily t-PA and u-PA) which takes place mainly in lysine rich areas on the surface of fibrin. These drugs block the binding sites of the enzymes or plasminogen respectively and thus stop plasmin formation.

They are used in menorrhagia and bleeding tendency due to various causes. Their application may be beneficial in patients with hyperfibrinolysis because they arrest bleeding rapidly if the other components of the haemostatic system are not severely affected. This may help to avoid the use of blood products such as fresh frozen plasma (FFP) with its associated risks of infections or anaphylactic reactions.

In 2010, the CRASH-2 trial showed that the antifibrinolytic drug tranexamic acid safely reduces mortality in bleeding trauma patients.^[2]

The antifibrinolytic drug aprotinin was abandoned after identification of major side effects, especially on the kidney.^{[citation needed]}

The indication for use of antifibrinolytic drugs is made with various methods. The most rapid and suitable one is thromboelastometry (TEM) in whole blood, which is even possible in patients on heparin. With various assays, an enhanced fibrinolysis becomes visible in the curve signature (TEMogram) and from the calculated values, e.g. the maximum lysis parameter. A special test for the identification of increased fibrinolysis (APTEM) compares the TEM in the absence or presence of the fibrinolysis inhibitor aprotinin. In severe cases of activated fibrinolysis, this assay confirms the syndrome already in less than 15 min during the early phases of clot formation ^[3]

References

^ "antifibrinolytic" at Dorland's Medical Dictionary
^ The CRASH-2 Collaborators (2010). "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial". Lancet. 376 (9734): 23–32. doi:10.1016/S0140-6736(10)60835-5. PMID 20554319.
^ Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, David JS. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Br J of Anaesthesia 2008;100:792-7.

External links

Antifibrinolytics at the US National Library of Medicine Medical Subject Headings (MeSH)
MeSH list of agents 82000933

UpToDate Contents

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English Journal

Obstetric bleeding among women with inherited bleeding disorders: a retrospective study.

Hawke L1, Grabell J1, Sim W1, Thibeault L2, Muir E1, Hopman W1, Smith G1, James P3,4.
Haemophilia : the official journal of the World Federation of Hemophilia.Haemophilia.2016 Oct 5. doi: 10.1111/hae.13067. [Epub ahead of print]
INTRODUCTION: Women with inherited bleeding disorders are at increased risk for bleeding complications during pregnancy and the postpartum period, particularly postpartum haemorrhage (PPH).AIM: This retrospective study evaluates pregnancy management through the Inherited Bleeding Disorders Clinic of
PMID 27704714

Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty.

Churchill JL1, Puca KE2, Meyer E3, Carleton M4, Anderson MJ5.
The journal of knee surgery.J Knee Surg.2016 Oct 3. [Epub ahead of print]
Multiple studies have shown tranexamic acid (TXA) to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA). Accordingly, TXA has become a routine blood conservation agent for TKA. In contrast, ε-aminocaproic acid (EACA), a similar acting antifibrinolytic to TX
PMID 27699724

Management of Coagulopathy in Postpartum Hemorrhage.

James AH1, Grotegut C1, Ahmadzia H2, Peterson-Layne C3, Lockhart E4.
Seminars in thrombosis and hemostasis.Semin Thromb Hemost.2016 Oct 3. [Epub ahead of print]
The purpose of this article is to review the use of blood products and hemostatic agents in the management of coagulopathy at the time of postpartum hemorrhage. Blood product administration strategies are broadly reviewed, including the role of the blood bank, the role of massive transfusion protoco
PMID 27699730

Japanese Journal

Usefulness of Intraoperative Continuous Infusion of Tranexamic Acid during Emergency Surgery for Type A Acute Aortic Dissection

Annals of Thoracic and Cardiovascular Surgery 21(1), 66-71, 2015
NAID 130004889802

Usefulness of Intraoperative Continuous Infusion of Tranexamic Acid during Emergency Surgery for Type A Acute Aortic Dissection

Annals of Thoracic and Cardiovascular Surgery, 2014
NAID 130003396770

同一家系内の遺伝性血管性浮腫の2例

日本集中治療医学会雑誌 18(4), 633-637, 2011
NAID 130004696426

「plasmin inhibitor」

　　[★]

プラスミン・インヒビター、プラスミン阻害因子

関: antifibrinolytic agent、antifibrinolytics、antiplasmin

「antiplasmin」

　　[★]

adj.

抗プラスミンの

n.

抗プラスミン薬

関: antifibrinolytic agent、antifibrinolytics、plasmin inhibitor

「antifibrinolytic agent」

　　[★]

抗線溶薬

関: antifibrinolytic、antifibrinolytics、antiplasmin、plasmin inhibitor

「antifibrinolytic」

　　[★]

adj.

抗線維素溶解性の

n.

抗線溶薬

関: antifibrinolytic agent、antifibrinolytics

[1] "antifibrinolytic" at Dorland's Medical Dictionary

[2] The CRASH-2 Collaborators (2010). "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial". Lancet. 376 (9734): 23–32. doi:10.1016/S0140-6736(10)60835-5. PMID 20554319.

[3] Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, David JS. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Br J of Anaesthesia 2008;100:792-7.

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Blood and blood forming organs (B)	Antithrombotics Antiplatelets Anticoagulants Thrombolytics/fibrinolytics Antihemorrhagics Platelets Coagulants Antifibrinolytics
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antifibrinolytics