氨甲环酸对创伤后高纤溶患者死亡率的影响。
The impact of tranexamic acid on mortality in injured patients with hyperfibrinolysis.
作者信息
Harvin John A, Peirce Charles A, Mims Mark M, Hudson Jessica A, Podbielski Jeanette M, Wade Charles E, Holcomb John B, Cotton Bryan A
机构信息
From the University of Texas Medical School at Houston, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2015 May;78(5):905-9; discussion 909-11. doi: 10.1097/TA.0000000000000612.
BACKGROUND
In 2011, supported by data from two separate trauma centers, we implemented a protocol to administer tranexamic acid (TXA) in trauma patients with evidence of hyperfibrinolysis (HF) on admission. The purpose of this study was to examine whether the use of TXA in patients with HF determined by admission rapid thrombelastography was associated with improved survival.
METHODS
Following institutional review board approval, we evaluated all trauma patients 16 years or older admitted between September 2009 and September 2013. HF was defined as LY-30 of 3% or greater. Patients with LY-30 less than 3.0% were excluded. Patients were divided into those who received TXA (TXA group) and those who did not (no-TXA group). After univariate analyses, a purposeful, logistic regression model was developed a priori to evaluate the impact of TXA on mortality (controlling for age, sex, Injury Severity Score (ISS), arrival physiology, and base deficit).
RESULTS
A total of 1,032 patients met study criteria. Ninety-eight (10%) received TXA, and 934 (90%) did not. TXA patients were older (median age, 37 years vs. 32 years), were more severely injured (median ISS, 29 vs. 14), had a lower blood pressure (median systolic blood pressure 103 mm Hg vs. 125 mm Hg), and were more likely to be in shock (median, base excess, -5 mmol/dL vs. -2 mmol/dL), all p < 0.05. Twenty-three percent of the patients had a repeat thrombelastography within 6 hours; 8.8% of the TXA patients had LY-30 of 3% or greater on repeat rapid thrombelastography (vs. 10.1% in the no-TXA group, p = 0.679). Unadjusted in-hospital mortality was higher in the TXA group (40% vs. 17%, p < 0.001). There were no differences in venous thromboembolism (3.3% vs. 3.8%). Logistic regression failed to find a difference in in-hospital mortality among those receiving TXA (odds ratio, 0.74; 95% confidence interval, 0.38-1.40; p 0.80).
CONCLUSION
In the current study, the use of TXA was not associated with a reduction in mortality. Further studies are needed to better define who will benefit from an administration of TXA.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
2011年，在来自两个独立创伤中心的数据支持下，我们实施了一项方案，对入院时有高纤溶（HF）证据的创伤患者给予氨甲环酸（TXA）。本研究的目的是检验对入院时通过快速血栓弹力图测定确定为HF的患者使用TXA是否与生存率提高相关。
方法
经机构审查委员会批准后，我们评估了2009年9月至2013年9月期间入院的所有16岁及以上的创伤患者。HF定义为LY-30≥3%。LY-30<3.0%的患者被排除。患者分为接受TXA的患者（TXA组）和未接受TXA的患者（非TXA组）。在单因素分析后，预先建立了一个有目的的逻辑回归模型，以评估TXA对死亡率的影响（控制年龄、性别、损伤严重程度评分（ISS）、入院时生理指标和碱缺失）。
结果
共有1032例患者符合研究标准。98例（10%）接受了TXA，934例（90%）未接受。接受TXA的患者年龄更大（中位年龄，37岁对32岁），受伤更严重（中位ISS，29对14），血压更低（中位收缩压103 mmHg对125 mmHg），更可能处于休克状态（中位碱剩余，-5 mmol/dL对-2 mmol/dL），所有p<0.05。23%的患者在6小时内进行了重复血栓弹力图检查；8.8%接受TXA的患者在重复快速血栓弹力图检查时LY-30≥3%（非TXA组为10.1%，p = 0.679）。TXA组未调整的住院死亡率更高（40%对17%，p<0.001）。静脉血栓栓塞方面无差异（3.3%对3.8%）。逻辑回归未能发现接受TXA的患者在住院死亡率方面存在差异（比值比，0.74；95%置信区间，0.38 - 1.40；p = 0.80）。
结论
在本研究中，使用TXA与死亡率降低无关。需要进一步研究以更好地确定谁将从TXA给药中获益。
证据水平
治疗性研究，IV级。
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