Tranexamic acid in severe trauma patients managed in a mature trauma care system

Boutonnet, Mathieu; Abback, Paer; Saché, Frédéric Le; Harrois, Anatole; Follin, Arnaud; Imbert, Nicolas; Andrew, P.; Trichereau, Julie; Ausset, Sylvain

doi:10.1097/ta.0000000000001880

Cited by 21 publications

(15 citation statements)

References 19 publications

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“…[ 3 , 4 ] Survival is achieved via a complex set of metabolic, endocrine, and immunological pathways that mobilize fuel sources and minimize blood loss, so that our vital organs may continue to be perfused and function. [ 5 ]…”

Section: Introductionmentioning

confidence: 99%

The effect of trauma care systems on the mortality of injured adult patients

Wu¹,

Yang²,

Zhu³

et al. 2020

Medicine

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Purpose: The aim of this study was to have a comprehensive evaluation of the effect of trauma care systems on the mortality of injured adult patients. Materials and methods: This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, EMBASE, Scopus, and the Cochrane Library were searched for all clinical trials evaluating the effect of trauma care systems on the mortality of injured adult patients until July 31, 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The odds ratio (OR) and 95% confidence intervals (CIs) were used as effect estimate. I-square (I 2 ) test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review. Results: The results will be published in a peer-reviewed journal. Conclusion: The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide a comprehensive evaluation of the effect of trauma care systems on the mortality of injured adult patients. Registration number: INPLASY202080058

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Section: Introductionmentioning

confidence: 99%

The effect of trauma care systems on the mortality of injured adult patients

Wu¹,

Yang²,

Zhu³

et al. 2020

Medicine

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“…Rats subjected to severe trauma develop an elevation over time in d-dimers, tPA, and plasmin activity [11], with a subsequent fall in clot strength (12). The activation of fibrinolysis and the loss of clot strength suggest mechanisms that would explain why anti-fibrinolytic drugs have demonstrated benefit in the treatment of trauma [13–16].…”

Section: Introductionmentioning

confidence: 99%

Effect of tranexamic acid administration on acute traumatic coagulopathy in rats with polytrauma and hemorrhage

Benov

Darlington

et al. 2019

PLoS ONE

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Trauma and hemorrhagic shock can lead to acute traumatic coagulopathy (ATC) that is not fully reversed by prehospital resuscitation as simulated with a limited volume of fresh whole blood (FWB) in a rat model. Tranexamic Acid (TXA) is used as an anti-fibrinolytic agent to reduce surgical bleeding if administered prior to or during surgery, and to improve survival in trauma if given early after trauma. It is not clear from the existing clinical literature whether TXA has the same mechanism of action in both settings. This study sought to explore the molecular mechanisms of TXA activity in trauma and determine whether administration of TXA as a supplement to FWB resuscitation could attenuate the established ATC in a rat model simulating prehospital resuscitation of polytrauma and hemorrhagic shock. In a parallel in-vitro study, the effects on clotting assays of adding plasmin at varying doses along with either simultaneous addition of TXA or pre-incubation with TXA were measured, and the results suggested that maximum anti-fibrinolytic effect of TXA on plasmin-induced fibrinolysis required pre-incubation of TXA and plasmin prior to clot initiation. In the rat model, ATC was induced by polytrauma followed by 40% hemorrhage. One hour after trauma, the rats were resuscitated with FWB collected from donor rats. Vehicle or TXA (10mg/kg) was given as bolus either before trauma (TXA-BT), or 45min after trauma prior to resuscitation (TXA-AT). The TXA-BT group was included to contrast the coagulation effects of TXA when used as it is in elective surgery vs. what is actually feasible in real trauma patients (TXA-AT group). A single dose of TXA prior to trauma significantly delayed the onset of ATC from 30min to 120min after trauma as measured by a rise in prothrombin time (PT). The plasma d-dimer as well as plasminogen/fibrinogen ratio in traumatized liver of TXA-BT were significantly lower as compared to vehicle and TXA-AT. Wet/dry weight ratio and leukocytes infiltration of lungs were significantly decreased only if TXA was administrated later, prior to resuscitation (TXA-AT). In conclusion: Limited prehospital trauma resuscitation that includes FWB and TXA may not correct established systemic ATC, but rather may improve overall outcomes of resuscitation by attenuation of acute lung injury. By contrast, TXA given prior to trauma reduced levels of fibrinolysis at the site of tissue injury and circulatory d-dimer, and delayed development of coagulopathy independent of reduction of fibrinogen levels following trauma. These findings highlight the importance of early administration of TXA in trauma, and suggest that further optimization of dosing protocols in trauma to exploit TXA’s various sites and modes of action may further improve patient outcomes.

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“…Testing currently includes viscoelastic tests such as rotational thromboelastometry or thromboelastography, thrombin generation tests, and clot waveform analysis, all of which help identify an abnormality in the clotting cascade. 50 One study found that thromboelastography-guided resuscitation during mass transfusion, as compared with conventional coagulation assay guidance, improved survival and required fewer plasma and platelet transfusions during the early phase of resuscitation. 42 Although more research is needed to support their use, these viscoelastic tests, referred to as viscoelastic monitoring, can guide correction of coagulopathy with specific blood product components or coagulation factor concentrates.…”

Section: Laboratory Testingmentioning

confidence: 99%

Contemporary Transfusion Science and Challenges

Passerini

2019

AACN Advanced Critical Care

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Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.

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Tranexamic acid in severe trauma patients managed in a mature trauma care system

Abstract: Therapeutic study, level III.

Cited by 21 publications

References 19 publications

The effect of trauma care systems on the mortality of injured adult patients

The effect of trauma care systems on the mortality of injured adult patients

Effect of tranexamic acid administration on acute traumatic coagulopathy in rats with polytrauma and hemorrhage

Contemporary Transfusion Science and Challenges

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