What is the recommended use and dosage of Etamsilato (etamsylate) in patients at risk of bleeding?

From the Guidelines

Etamsylate is not recommended as a first-line treatment for patients at risk of bleeding, as the most recent and highest quality evidence supports the use of tranexamic acid instead. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation 1 does not mention etamsylate as a recommended treatment for bleeding. In contrast, the 2013 European guideline on the management of bleeding and coagulopathy following major trauma recommends the use of tranexamic acid as an antifibrinolytic agent to reduce the risk of death due to bleeding 1.

Key Points to Consider

• Tranexamic acid is recommended for patients at risk of bleeding, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h 1
• Etamsylate may not be as effective as tranexamic acid in reducing the risk of bleeding, and its use is not supported by the most recent and highest quality evidence
• The medication of choice for patients at risk of bleeding should be based on the most recent and highest quality evidence, with a focus on reducing morbidity, mortality, and improving quality of life

Dosage and Administration

• Tranexamic acid should be administered as early as possible to the trauma patient who is bleeding or at risk of significant hemorrhage, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h 1
• The use of etamsylate is not recommended, as it is not supported by the most recent and highest quality evidence

Special Considerations

• Patients with porphyria or severe renal impairment may require dose adjustments or alternative treatments
• Etamsylate is not a substitute for surgical intervention when indicated for active bleeding
• The use of antifibrinolytic agents, such as tranexamic acid, should be considered in patients at risk of bleeding, especially in situations of severe bleeding where many factors of the coagulation cascade are deficient 1

From the Research

Uso de Etamsilato

• El etamsilato se ha utilizado para reducir el sangrado en diversas patologías, como metrorragias, sangrado intraventricular, prostatectomías, cirugías de catarata y amigdalectomías 2.
• Un estudio realizado en 2018 evaluó la efectividad del etamsilato para disminuir el sangrado en la cirugía de reemplazo total de cadera, pero no se demostró un efecto significativo en la reducción de la hemorragia en pacientes sometidos a este procedimiento 2.

Dosificación y Uso

• No se encontraron estudios que proporcionen información específica sobre la dosificación y el uso de etamsilato en pacientes con riesgo de sangrado.
• Sin embargo, se sabe que el etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologías, lo que sugiere que podría ser una opción para pacientes con riesgo de sangrado 2.

Consideraciones Generales

• La prevención y el tratamiento del sangrado en pacientes que utilizan agentes antitrombóticos es un desafío importante 3.
• La identificación de pacientes de alto riesgo y la estratificación de subgrupos de pacientes son estrategias importantes para abordar este desafío 3.
• La administración de regímenes de riesgo adaptados y la utilización de agentes hemostáticos como el etamsilato podrían ser opciones para prevenir y tratar el sangrado en pacientes con riesgo de sangrado 2, 3.