Morrison Jonathan J, Dubose Joseph J, Rasmussen Todd E, Midwinter Mark J
US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA.
Arch Surg. 2012 Feb;147(2):113-9. doi: 10.1001/archsurg.2011.287. Epub 2011 Oct 17.
To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality.
Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival.
A Role 3 Echelon surgical hospital in southern Afghanistan.
A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries.
Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications.
The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P < .001). This benefit was greatest in the group of patients who received massive transfusion (14.4% vs 28.1%, respectively; P = .004), where TXA was also independently associated with survival (odds ratio = 7.228; 95% CI, 3.016-17.322) and less coagulopathy (P = .003).
The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
描述氨甲环酸（TXA）在战伤中的当代应用情况，并评估其给药对全血制品使用、血栓栓塞并发症和死亡率的影响。
回顾性观察研究，比较接受至少1单位浓缩红细胞的患者中使用TXA与未使用TXA的情况。还对接受大量输血（≥10单位浓缩红细胞）的患者亚组进行了检查。采用单因素和多因素回归分析来确定与生存相关的参数。使用Kaplan-Meier生存表报告生存率。
阿富汗南部的一家三级梯队外科医院。
从前瞻性收集的英国和美国创伤登记处识别出896例连续入院的战伤患者，其中293例接受了TXA治疗。
24小时、48小时和30天的死亡率，以及TXA给药对术后凝血病和血栓栓塞并发症发生率的影响。
尽管TXA组受伤更严重（平均[标准差]损伤严重度评分分别为25.2[16.6]和22.5[18.5]；P<.001），但其未调整死亡率低于未使用TXA组（分别为17.4%和23.9%；P=.03）。这种益处在接受大量输血的患者组中最为显著（分别为14.4%和28.1%；P=.004），在该组中TXA还与生存独立相关（比值比=7.228；95%可信区间，3.016 - 17.322）且凝血病较少（P=.003）。
战伤后使用TXA进行基于血液成分的复苏可改善凝血病指标和生存率，这一益处在需要大量输血的患者中最为突出。TXA治疗应作为战时严重创伤和出血后复苏策略的一部分应用于临床实践。
