The effects of tranexamic acid and prothrombin complex concentrate on the coagulopathy of trauma

Abstract

Both TXA and PCC seem to function well in reversing a traumatic coagulopathy in vitro, and TXA seems to have no loss of function in a severe metabolic acidosis. Further investigations are warranted.

Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting

“…94,95 In a retrospective, observational single-center study of 45 trauma patients, 3F-PCCs (Profilnine®; Grifols Biologicals, Los Angeles, CA) reversed clinical bleeding and INR to ≤1.5 at a mean dose of 25 IU/kg in both warfarin (n = 25, P ≤ 0.001) and nonwarfarin (n = 20, P ≤ 0.001) groups. 96 Both groups experienced refractory bleeding after receiving plasma.…”

Tranexamic acid corrects fibrinolysis in the presence of acidemia in a swine model of severe ischemic reperfusion

“…Our resuscitation protocol is straightforward and standardized, allowing our investigators to test various interventions and study drugs over a period. 14,22 The role of severe hyperfibrinolysis seen in ATC is further elucidated as improved technology with ROTEM allows both researchers and clinicians to identify and treat patients previously not identified with traditional laboratory values such as PT/PTT/INR and fibrinogen. 23Y25 TXA, an antifibrinolytic, has shown promise in clinical studies such as the CRASH-2 and MATTERS trial, but few data are available regarding basic science, animal data in underlying mechanism, pharmacokinetics, as well as efficacy and anti-inflammatory effects of TXA in the treatment of severely injured trauma patients.…”

“…In comparing between recombinant tissue plasminogen activator (rtPA, Genentech, San Francisco, CA) and TXA groups in terms of rotational thromboelastometry (ROTEM) with an effect size of 0.001 (9% vs. 99%, based on previous in vitro studies) with an > of 5% and statistical power of 80%, the minimum required samples size to capture such effect was five animals in each group. 14 The protocol for our trauma porcine model has been previously described (Fig. 1).…”

Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

“…More recently, early fibrinolysis, platelet dysfunction, clotting factor inactivation and depletion, were described in acute traumatic coagulopathy [18][19][20] . To approach those multiple conditions, pharmacological agents have been incorporated in the management of coagulopathy 6,7 .…”

“…Hence, pre-emptive treatment of this condition has gained considerable support 4,5 . The addition of procoagulant pharmacological agents to that treatment strategy has shown promising results 6,7 . Because of the multifactorial nature of TAC, it is conceivable that pharmacological agents with distinct pro-coagulant effects may be employed synergistically to treat this condition .…”