Tranexamic acid through intravenous,intramuscular and oral routes: an individual participant data meta‐analysis of pharmacokinetic studies in healthy volunteers

Tranexamic acid (TXA) is an antifibrinolytic drug that reduces surgical blood loss and death due to bleeding after trauma and post‐partum haemorrhage. One key issue for treatment success is early administration. While usually given intravenously, oral and intramuscular use would be useful in specific circumstances. Therefore, an understanding of TXA pharmacokinetics when given via different routes is valuable. The aim of this study was to perform an individual participant data meta‐analysis of pharmacokinetic studies with TXA given to healthy volunteers via different routes. We searched the following databases: PubMed, Web of Science, Wiley Online Library, Elsevier Science Direct and J‐STAGE. Individual subject data were extracted when available, otherwise arithmetic means were used. A population pharmacokinetic model was developed using nonlinear mixed effect modelling. Seven studies were included in the analysis with data from 10 patients for the IV route, six patients for the IM route and 114 patients for the oral route. The pharmacokinetics was ascribed to a two‐compartment model, and the main covariate was allometrically scaled bodyweight. Oral and IM bioavailabilities were 46 and 105%, respectively. For a 70 kg bodyweight, the population estimates were 7.6 L/h for clearance, 17.9 L for the volume of the central compartment, 2.5 L/h for the diffusional clearance and 16.6 L for the peripheral volume of distribution. Larger well‐designed studies are needed to describe the pharmacokinetics of TXA when given IM or as an oral solution before these can be recommended as alternatives to IV.     

Concilier le diagnostic anténatal et l’incertitude

The antenatal diagnosis is ambiguous.We expect a positive information. The misunderstanding is that parents have always to live with an existential doubt. They project and expect that professional avoid doubt and help them to take rational decision. Professionals only support parents with a conciliation between a rigourous feedback information and the uncertainty. Antenatal diagnosis always deals with uncertainty.     

Spinal cord compression from a malignant pleural mesothelioma

Thoracoscopy-talc led to the diagnosis of epithelial pleural mesothelioma in a 58-year-old man who presented with pleurisy. The course was rapidly unfavorable despite systemic chemotherapy. Dorsal pain revealed invasion of the spine and spinal canal leading to cord compression three months after the diagnosis of mesothelioma.     

Withholding and withdrawing treatment in the perinatal period: importance of a coherent attitude between gyneco-obstetricians and pediatricians

According to several recent surveys, 50% of deaths occurring in neonatal intensive care units in France occur subsequent to a medical decision. The French Neonatal Group therefore decided to publish guidelines for practice. These guidelines present: definitions, clinical situations, ethical principles, obligations of the medical and nursing staff, and specific conditions where dilemmas occur. These guidelines focus on the obstetrico-pediatrics relationship.     

Souffrance et société libérale

The intolerance of suffering is co-substantial in modern liberal society. Constructed as a peaceful project, the liberal societies have substituted the symbolic mediation by the process of regulation and the management of suffering. The symbolism that accompanies, in order to make sense, has been replaced by a corrective rationalisation of the disorder that represents suffering. The legalism, the medicalisation and the other social modality of compensation tend to, individually and collectively, make suffering an anthropologic and social abnormality.