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The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals for the management of antiplatelet therapy in patients undergoing elective invasive procedures. The proposals were discussed and validated by a vote; all proposals but one could be assigned with a high strength. The management of antiplatelet therapy is based on their indication and the procedure. The risk of bleeding related to the procedure can be divided into high, moderate and low categories depending on the possibility of performing the procedure in patients receiving antiplatelet agents (none, monotherapy and dual antiplatelet therapy respectively). If discontinuation of antiplatelet therapy is indicated before the procedure, a last intake of aspirin, clopidogrel, ticagrelor and prasugrel 3, 5, 5 and 7 days before surgery respectively is proposed. The thrombotic risk associated with discontinuation should be assessed according to each specific indication of antiplatelet therapy and is higher for patients receiving dual therapy for coronary artery disease (with further refinements based on a few well-accepted items) than for those receiving monotherapy for cardiovascular prevention, for secondary stroke prevention or for lower extremity arterial disease. These proposals also address the issue of the potential role of platelet functional tests and consider management of antiplatelet therapy for regional anaesthesia, including central neuraxial anaesthesia and peripheral nerve blocks, and for coronary artery surgery., SCOPUS: ar.j, info:eu-repo/semantics/published

Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.Systematic review with meta-analysis.Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P=0.03) and confirmed after 6 hours (median: 170mL (58-323) vs 221mL (110-543), P=0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.

Every year, more than a million people die as a result of trauma. This huge mortality could be partially explained by the development of an acute traumatic coagulopathy, present in a large part of all major trauma patients, soon after injury, which contributes to ongoing hemorrhage. The coagulopathy induced by trauma is independently associated with mortality, increased transfusion requirements, multiple organ dysfunction, infections, increased intensive care unit (ICU) length of stay, and costs. The pathophysiological mechanisms implicated in this acute traumatic coagulopathy are complexes and lead to generate a vicious circle leading to the activation of different pathways: thrombin generation, plasmin generation, inflammation activation. All of these processes will impair the balance between clot formation and clot lysis, with an increased tendency of hyperfibrinolysis. In 2010, the CRASH-2 trial demonstrated that tranexamic acid (TXA) administration was associated with a reduction in all cause mortality (14.5% vs. 16%, P=0.0035), including the risk of death due to bleeding (4.9% vs. 5.8%, P=0.0077), without an increase in fatal or non-fatal vascular occlusive events. Finally, the CRASH-3 trial is now recruiting patients with traumatic brain injury without extracranial bleeding. This study aims at determining the safety and efficacy of TXA administration in this particular setting. Our experience from the cardiac surgery setting highlighted a dose-dependent increased seizure incidence associated with the administration of TXA. For this reason, further studies are needed to better define the "optimal" dose scheme based on pharmacokinetic and pharmacodynamic studies.