Roberts Ian
Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK.
Transfusion. 2016 Apr;56 Suppl 2:S115-8. doi: 10.1111/trf.13490.
Administration of tranexamic acid (TXA) to bleeding trauma patients who are within 3 hours of injury has been shown to safely reduce mortality in bleeding trauma patients. However, some believe that thromboelastography (TEG or ROTEM) can be used to subdivide these patients into those that will benefit from TXA and those that will be harmed by it. If thromboelastography can be used in this way there could be important patient benefits. However, if the approach is misguided, patients could be denied a lifesaving treatment. I believe that rather than debate the theoretical basis of this hypothesis, it should be tested by conducting a randomized controlled trial. Bleeding trauma patients who are within 3 hours of injury should be randomly allocated to receive TXA treatment or thromboelastometry-guided TXA treatment with the risk of death and complications compared between the groups. An adequately powered clinical trial would better serve patient interest than ongoing debate.
已证明，在受伤3小时内对出血性创伤患者使用氨甲环酸（TXA）可安全降低出血性创伤患者的死亡率。然而，一些人认为，血栓弹力图（TEG或ROTEM）可用于将这些患者分为将从TXA中获益的患者和将因TXA而受伤害的患者。如果血栓弹力图能以这种方式使用，可能会给患者带来重要益处。然而，如果这种方法被误导，患者可能会被剥夺一种救命治疗。我认为，与其争论这一假设的理论基础，不如通过进行一项随机对照试验来对其进行检验。应将受伤3小时内的出血性创伤患者随机分配接受TXA治疗或血栓弹力测定法指导的TXA治疗，并比较两组之间的死亡风险和并发症。一项有足够效力的临床试验比持续的争论更符合患者利益。
