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.     

Is arterial hypertension in women different from that in men? Example of the relationship between arterial pressure and left ventricular mass

In the Bordeaux cohort of never treated, uncomplicated hypertensive patients with office BP > 140/90 on at least 2 occasions, we selected those with good quality 24 H ambulatory BP measurement and LVM measured with M mode echo before any antihypertensive treatment. In this group, we studied the relationships between LVM and average 24 h systolic BP in males and females in univariate and multivariate analysis, taking into account age, weight and height. The population studied included 531 patients whose main characteristics are summarized in the table. The slope of the relationship between LVM and 24 h SBP is significantly steeper in males than in females (1.73 vs 0.58, p < 0.01). In multivariate analysis, the variable showing the higher correlation to LVM is 24 h SBP in males, weight in females. For a similar increase in BP, males hypertensive show a higher increase in LVM than females.     

Undiagnosed rupture of right hemidiaphragm--hepatothorax: a case report

A case of late diagnosis of right diaphragmatic rupture due to blunt trauma is presented. Traumatic diaphragmatic rupture is an uncommon but severe problem in a patient with multiple injuries. One third of left-sided ruptures and half of right-sided ruptures have been undetected for several days. Traumatic diaphragmatic rupture should be suspected on the basis of an abnormal chest X-ray in patients with multiple injuries. Imaging studies like computed tomography, scan and magnetic resonance imaging can be helpful for differential diagnosis. Right-sided injuries occur more commonly than previously thought and often require thoracotomy.