From the Institute of Anesthesiology, University and University Hospital Zurich, Switzerland.
Swiss Air-Ambulance, Rega (Rettungsflugwacht/Garde Aérienne), Zurich, Switzerland.
Anesth Analg. 2018 Feb;126(2):522-529. doi: 10.1213/ANE.0000000000002708.
There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA.
The study protocol was registered at ClinicalTrials.gov (NCT02354885). A prospective, multicenter, observational study investigating coagulation status in 70 trauma patients receiving TXA (1 g intravenously) on-scene versus a control group of 38 patients previously published without TXA. To account for potential differences in patient and trauma epidemiology, crystalloid and colloidal resuscitation fluid, 2 propensity score matched groups (n = 24 per group) were created. Measurements included ROTEM, standard coagulation tests and blood gas analyses on-scene and emergency department admission. Presented values are mean and [standard deviation], and difference in means and 95% confidence intervals.
Patient epidemiology was not different between groups. Coagulation assays on-scene were comparable between the TXA and C. Prehospital hyperfibrinolysis was blunted in all 4 patients in the TXA group. Viscoelastic FIBTEM maximum clot firmness (MCF), representing functional fibrinogen levels, did not change from on-scene to the emergency department in the TXA group, whereas MCF decreased -3.7 [1.8] mm in the control group. Decrease of MCF was significantly reduced in the TXA group in EXTEM by 9.2 (7.2-11.2) mm (P < .001) and INTEM by 6.8 (4.7-9.0) mm (P < .001) in favor of the TXA group. Production of fibrinogen fragments (represented by D-dimers) was significantly lower in the TXA group compared to group C.
Early prehospital administration of TXA leads to clot stabilization and a reduction of fibrinolytic activity, causing a decrease in fibrin degradation products buildup (D-dimer).
关于民用创伤中氨甲环酸（TXA）的院前管理，数据有限。本研究的目的是评估 TXA 应用前后从现场到医院的严重创伤后凝血的变化，并与之前没有 TXA 的研究进行比较。
该研究方案在 ClinicalTrials.gov 注册（NCT02354885）。一项前瞻性、多中心、观察性研究，调查了 70 例接受 TXA（静脉内 1 克）现场治疗的创伤患者与之前发表的无 TXA 对照组 38 例患者的凝血状态。为了考虑患者和创伤流行病学的潜在差异，创建了 2 个晶体和胶体复苏液的倾向评分匹配组（每组 24 例）。测量包括 ROTEM、标准凝血试验和血气分析在现场和急诊入院时进行。给出的数值为平均值和[标准差]，以及平均值差异和 95%置信区间。
两组患者的流行病学特征无差异。TXA 组和 C 组的现场凝血试验结果相似。TXA 组的所有 4 例患者的院前高纤溶状态均得到缓解。在 TXA 组，弹性纤维蛋白原 FIBTEM 最大凝块硬度（MCF），代表功能性纤维蛋白原水平，从现场到急诊室没有变化，而对照组 MCF 下降了-3.7 [1.8] mm。TXA 组 EXTEM 中 MCF 下降幅度显著减少 9.2（7.2-11.2）mm（P <.001），INTEM 中 MCF 下降 6.8（4.7-9.0）mm（P <.001），TXA 组更有利。与 C 组相比，TXA 组纤维蛋白原片段（代表 D-二聚体）的产生显著降低。
早期院前应用 TXA 可导致血栓稳定和纤溶活性降低，减少纤维蛋白降解产物的堆积（D-二聚体）。
