Douglas Alisha, Faviere Donna, Gallo Amber, VanderSchaaf Ashley, Wall Ward, Wilson Kayla, Young Ashley
Department of Trauma Services (Mss Douglas and Gallo and Dr Wall), Department of Emergency Medicine (Mss Faviere and Young), Department of Perioperative Services (Ms VanderSchaaf), Department of Emergency Medicine/Pharmacy (Dr Wilson), Lakeland Regional Health, Lakeland, Florida.
J Trauma Nurs. 2020 Mar/Apr;27(2):66-70. doi: 10.1097/JTN.0000000000000488.
Antifibrinolytics have demonstrated a mortality benefit in trauma patients when utilized early after injury. In line with recent literature, the authors hypothesize that early tranexamic acid (TXA) administration will decrease overall blood product administration at 24 hr. This is a retrospective cohort evaluation of 65 trauma patients admitted and discharged between May 1, 2015, and December 31, 2017, who received packed red blood cells (PRBCs) and TXA within 3 hr following injury. The primary outcome was overall PRBC utilization at 24 hr when TXA was administered less than 1 hr of injury compared with 1-3 hr of injury. A subgroup analysis compared PRBC usage at 24 hr when PRBC to TXA administration time was less than 30 min compared with 30 min or more. During the study time, 15 patients received TXA early, less than 1 hr from injury, and 50 patients received TXA within 1-3 hr of injury. Patients received a median of 7 units of PRBCs in the early group and 8 units in the standard group (p = .64) at 24 hr. Patients who received TXA less than 30 min after first PRBC received a median of 6 units at 24 hr compared with 9 units when PRBC to TXA time was 30 min or more (p = .014). There was no difference in PRBCs at 24 hr in patients who received TXA early compared with 1-3 hr from injury. There was a significant increase in PRBC requirement at 24 hr when patients received TXA 30 min or more from first PRBC. Further inquiry into the optimal timing of TXA administrated is needed.
抗纤溶药物在创伤患者受伤后早期使用时已显示出降低死亡率的益处。与近期文献一致，作者推测早期给予氨甲环酸（TXA）将减少24小时内血液制品的总体使用量。这是一项回顾性队列评估，研究对象为2015年5月1日至2017年12月31日期间入院并出院的65例创伤患者，这些患者在受伤后3小时内接受了浓缩红细胞（PRBC）和TXA。主要结局是当TXA在受伤后不到1小时给予时与受伤后1 - 3小时给予时相比，24小时时PRBC的总体使用情况。亚组分析比较了PRBC与TXA给药时间小于30分钟时与30分钟或更长时间时24小时的PRBC使用情况。在研究期间，15例患者在受伤后不到1小时早期接受了TXA，50例患者在受伤后1 - 3小时内接受了TXA。早期组患者在24小时时接受PRBC的中位数为7单位，标准组为8单位（p = 0.64）。首次接受PRBC后不到30分钟接受TXA的患者在24小时时接受PRBC的中位数为6单位，而PRBC与TXA时间为30分钟或更长时间时为9单位（p = 0.014）。受伤后早期接受TXA的患者与受伤后1 - 3小时接受TXA的患者在24小时时PRBC使用情况无差异。当患者在首次接受PRBC后30分钟或更长时间接受TXA时，24小时时PRBC需求量显著增加。需要进一步探究TXA给药的最佳时机。
