From the Department of Surgery (M.D., Q.H., C.R.P., S.S., M.E., M.M.), Madigan Army Medical Center, Tacoma, Washington; Legacy Emanuel Medical Center (S.I.), Portland, Oregon; and Baltimore Shock-Trauma Institute (J.D.), Baltimore, Maryland.
J Trauma Acute Care Surg. 2014 Mar;76(3):625-32; discussion 632-3. doi: 10.1097/TA.0000000000000143.
Tranexamic acid (TXA) is an antifibrinolytic with anti-inflammatory properties associated with improved outcomes when administered to trauma patients at risk for bleeding; however, its efficacy is unknown in acidemia. We evaluated the efficacy of TXA on hyperfibrinolysis using an established porcine traumatic hemorrhage ischemic shock model.
Ten Yorkshire swine underwent a controlled hemorrhage followed by supraceliac aortic cross-clamping. During standard resuscitation, control animals received recombinant tissue plasminogen activator (rtPA) after cross-clamp removal, and experimental animals received rtPA followed by TXA. Rotational thromboelastometry analysis was performed at baseline, 5 minutes and 15 minutes after rtPA dosing, and 4 hours after cross-clamp removal.
Control and experimental animals had similar hemodynamics and routine laboratory values at baseline and throughout resuscitation. At the time of TXA administration, average pH was 7.2. Clot formation time was prolonged from baseline and all resuscitation time points in both groups, with no difference at any time point. Maximum clot firmness decreased from baseline at all resuscitation time points in both groups. Maximum lysis increased from baseline (9% control vs. 9% TXA) after tissue plasminogen activator administration in both groups (100% control vs. 99% TXA). In experimental animals, maximum lysis returned to baseline 10 minutes after TXA administration (92% vs. 9%, p < 0.001).
TXA rapidly and fully reverses hyperfibrinolysis despite severe acidemia in a porcine trauma model. TXA is a promising adjunct to trauma resuscitation that is easily administered in austere or prehospital settings.
氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，具有抗炎特性，与出血风险的创伤患者使用后改善结果相关；然而，其在酸中毒中的疗效尚不清楚。我们使用已建立的猪创伤性出血性休克模型评估 TXA 对过度纤溶的疗效。
10 头约克夏猪接受控制性出血，然后进行腹主动脉上方的阻断。在标准复苏期间，对照组动物在阻断夹移除后接受重组组织型纤溶酶原激活剂（rtPA），实验组动物接受 rtPA 后给予 TXA。在 rtPA 给药后 5 分钟和 15 分钟以及阻断夹移除后 4 小时进行旋转血栓弹性测定分析。
对照组和实验组在基线时和整个复苏期间的血流动力学和常规实验室值相似。在给予 TXA 时，平均 pH 值为 7.2。两组的凝块形成时间均从基线和所有复苏时间点延长，任何时间点均无差异。两组的最大凝块硬度均从基线下降。两组在组织型纤溶酶原激活剂给药后最大纤溶增加（对照组为 9%，TXA 为 9%）（对照组为 100%，TXA 为 99%）。在实验组中，TXA 给药后 10 分钟最大纤溶恢复至基线（92%比 9%，p < 0.001）。
TXA 可迅速且完全逆转严重酸中毒猪创伤模型中的过度纤溶。TXA 是一种有前途的创伤复苏辅助药物，在艰苦或院前环境中易于给药。
