Kunze-Szikszay Nils, Krack Lennart A, Wildenauer Pauline, Wand Saskia, Heyne Tim, Walliser Karoline, Spering Christopher, Bauer Martin, Quintel Michael, Roessler Markus
Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Department for Trauma Surgery and Orthopaedics, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Scand J Trauma Resusc Emerg Med. 2016 Oct 10;24(1):122. doi: 10.1186/s13049-016-0314-4.
Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system.
From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM.
The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration.
HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease.
The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption.
ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).
高纤溶状态（HF）是创伤患者凝血病和死亡的主要原因。本研究调查了（i）多发伤患者院前处理期间的HF发生率，以及（ii）院前给予氨甲环酸（TxA）对凝血系统的影响。
选取27例院前估计损伤严重度评分（ISS）≥16分的创伤患者，在现场及入院至急诊科（ED）时采集血液样本。所有患者在采集第一份血样后接受1g TxA。对两份血样均进行旋转血栓弹力图（ROTEM）检测，并比较结果。HF定义为EXTEM中最大溶解率（ML）>15%。
ISS中位数（最小值 - 最大值）为17分（4 - 50分）。4例患者（15%）在现场通过ROTEM诊断为HF，2例患者（7.5%）在入院至ED时通过ROTEM诊断为HF。给予TxA前ML中位数为11%（3% - 99%），给予TxA后为10%（4% - 18%；p>0.05）。TxA在到达ED前37分钟（10 - 85分钟）给予。给予TxA前后ROTEM结果无显著差异。给予TxA后未观察到药物不良反应。
严重受伤患者在院前护理期间可能存在HF。在现场给予抗纤溶治疗可显著节省时间。即使在较轻的创伤中，纤维蛋白原也可能降至极低水平。早期给予TxA无法逆转或完全阻止这种下降。
对于严重受伤患者，应考虑院前使用TxA，以防止创伤性凝血病恶化和不必要的高纤维蛋白原消耗。
ClinicalTrials.gov标识符NCT01938768（2013年9月5日注册）
