Tranexamic acid partially improves platelet function in patients treated with dual antiplatelet therapy

Weber, Christian Friedrich; Görlinger, Klaus; Byhahn, Christian; Moritz, Anton; Hanke, Alexander; Zacharowski, Kai; Meininger, Dirk

doi:10.1097/eja.0b013e32834050ab

Cited by 86 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the past five years, MEA has become an important and widely used diagnostic tool for coagulation monitoring with respect to hereditary [8] and acquired [7,[9][10][11][12][13] platelet dysfunction, as well as surveillance of platelet inhibitor effects [14][15][16][17][18][19], as shown by many studies. Taking less than 10 minutes, MEA allows conclusions to be drawn about the patient's platelet function from standardized test procedures that are easy to perform.…”

Section: Introductionmentioning

confidence: 99%

Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry

et al. 2012

View full text Add to dashboard Cite

Pneumatic tube systems (PTS) present a convenient way for blood sample transport in medical facilities. Associated preanalytical interference in various tests is largely unknown. Implementing point-of-care coagulation management at our institution, we investigated multiple electrode aggregometry (MEA) and rotational thromboelastometry (ROTEM) after PTS transportation. Whole blood samples from patients undergoing general or trauma surgery were analysed by MEA after collection (baseline, '0 × PTS') and sent on a predefined PTS track (n = 12). MEA was repeated after samples travelled the track 4 ('4 × PTS'), 8 ('8 × PTS') and 12 times ('12 × PTS') and compared with stationary controls analysed at the same time. Samples for ROTEM (n = 6) were analysed after collection and travelling the track 12 times. An acceleration detector recorded g-forces on the PTS track. At '0 × PTS' no significant differences in MEA results were detected. Values were significantly lower for transported samples compared with controls ('4 × PTS' to '12 × PTS', p < 0.001). Furthermore, MEA results of PTS samples were significantly decreased for '4 × PTS' to '12 × PTS' compared to baseline (p < 0.001). Except for the clotting time in EXTEM PTS transport did not significantly alter results for investigated ROTEM parameters, compared with baseline and stationary controls. Acceleration detector readout revealed alternating g-forces between -6.3 and +5.9 during transport. PTS transport caused invalid results in MEA while only one ROTEM parameter was found to be affected in this study. Variable acceleration during transport provides a potential reason for platelet activation. The authors recommend sample transport by hand or the device to be placed patient-side when MEA is performed.

show abstract

Section: Introductionmentioning

confidence: 99%

Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry

et al. 2012

View full text Add to dashboard Cite

show abstract

“…It has been reported that fibrinogen supplementation is associated with recovery of platelet aggregation in antiplatelet-treated samples13 and reduces bleeding in thrombocytopenic pigs 14. TXA, the lysine analogue antifibrinolytic drug, also restores in part whole blood (WB) platelet aggregation in patients receiving aspirin and clopidogrel 15. Finally, administration of FXIII, the fibrin clot-stabilizing agent, increases clot firmness,16 in particular in Glanzmann thrombasthenia17 and partly overturns antithrombotic-induced impairment in clot structure.…”

Section: Introductionmentioning

confidence: 99%

Ticagrelor reversal:in vitroassessment of four haemostatic agents

et al. 2017

View full text Add to dashboard Cite

show abstract

“…What is the minimal effective concentration of TXA require to inhibit this fibrinolysis? Does TXA mechanism of action only work by fibrinolysis inhibition or by a combination with inflammatory pathway inhibition, and/or platelet function improvement [4]?…”

Section: Abstract Tranexamic Acid á Pediatric Cardiac Surgery á Transmentioning

confidence: 99%

Use of tranexamic acid in pediatric cardiac surgery: we really need more

2011

View full text Add to dashboard Cite

To the Editor:I read with interest the recent article of Shimizu et al. [1]. First, I congratulate the authors for their work and their wish to improve our knowledge about the use of tranexamic acid (TXA) in congenital heart surgery (CHS). It appears more and more evident that if TXA could reduce blood loss, the clinical benefit of this drug does not appear so evident. Indeed, if we analyze the available literature comparing TXA to placebo in terms of blood loss but also transfusion requirement, the results of the analysis indicate that TXA marginally decreases blood-product transfusion compared with placebo in the pediatric population. The results obtained for postoperative blood loss and other outcomes, such as re-exploration, are generally too heterogeneous, and no clear results could be interpreted [2]. As the authors wrote, the variability in the dosage schemes used in the different studies is striking. Moreover, the choice of TXA dosage was not based on pharmacokinetic (PK) data regarding the fibrinolytic inhibiting activity of the drug; instead, dosage choice was empirical based on its effects on blood loss. In fact, no pharmacological data on TXA are available in the pediatric cardiac surgery population. PK data have been determined in adults, and suggest the administration of a loading dose of 12.5 mg/kg given over 30 min, a maintenance infusion of 6.5 mg/kg/h, and a cardiopulmonary bypass (CPB) priming dose of 1 mg/kg to maintain TXA concentration in blood [345 lM/ml [3]. This dosage scheme is clearly smaller than those used in the different pediatric trials. Another lack of evidence in the use of TXA is the pharmacodynamic (PD) evaluation. Indeed, no randomized controlled trials have evaluated the effect of CPB on fibrinolysis activation with the currently available monitoring (thromboelastography, rotation thromboelastometry, or standard biological tests). What is the exact frequency rate of hyperfibrinolysis during CPB in CHS? What is the minimal effective concentration of TXA require to inhibit this fibrinolysis? Does TXA mechanism of action only work by fibrinolysis inhibition or by a combination with inflammatory pathway inhibition, and/or platelet function improvement [4]?In the pediatric population, side effects related to TXA administration are not well established. Most of the studies available have evaluated the effect on bleeding and bloodproduct requirements, but none were designed to evaluate postoperative outcomes in the population. Actually, only two retrospective cohort studies reported side effects related to TXA administration during pediatric cardiac surgery [5]. They found 9.6% renal injury, 1.8% renal failure, 3.5% seizure, and 2.6% other neurological events. According to their results, more than 500 patients per group are needed to evaluate side effects related to TXA administration.In conclusion, the article by Shimizu et al. offers another study and another reason to believe that we need more evaluations! We need to describe the PK in the pediatric population; we need to evaluat...

show abstract

Tranexamic acid partially improves platelet function in patients treated with dual antiplatelet therapy

Cited by 86 publications

References 32 publications

Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry

Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry

Ticagrelor reversal:in vitroassessment of four haemostatic agents

Use of tranexamic acid in pediatric cardiac surgery: we really need more

Contact Info

Product

Resources

About