Department of Surgery, Brown University, Alpert School of Medicine, Providence, Rhode Island.
Department of Surgery, Brown University, Alpert School of Medicine, Providence, Rhode Island.
J Surg Res. 2021 Feb;258:125-131. doi: 10.1016/j.jss.2020.08.045. Epub 2020 Sep 30.
Early administration of tranexamic acid (TXA) has been widely implemented for the treatment of presumed hyperfibrinolysis in hemorrhagic shock. We aimed to characterize the liberal use of TXA and whether unjustified administration was associated with increased venous thrombotic events (VTEs).
We identified injured patients who received TXA between January 2016 and January 2018 by querying our Level 1 trauma center's registry. We retrospectively reviewed medical records and radiologic images to classify whether patients had a hemorrhagic injury that would have benefited from TXA (justified) or not (unjustified).
Ninety-five patients received TXA for traumatic injuries, 42.1% were given by emergency medical services. TXA was considered unjustified in 35.8% of the patients retrospectively and in 52% of the patients when given by emergency medical services. Compared with unjustified administration, patients in the justified group were younger (47.6 versus 58.4; P = 0.02), more hypotensive in the field (systolic blood pressure: 107 ± 31 versus 137 ± 32 mm Hg; P < 0.001) and in the emergency department (systolic blood pressure: 97 ± 27 versus 128 ± 27; P < 0.001), and more tachycardic in emergency department (heart rate: 99 ± 29 versus 88 ± 19; P = 0.04). The justified group also had higher injury severity score (median 24 versus 11; P < 0.001), was transfused more often (81.7% versus 20.6%; P < 0.001), and had higher in-hospital mortality (39.3% versus 2.9%; P < 0.001), but there was no difference in the rate of VTE (8.2% versus 5.9%).
Our results highlight a high rate of unjustified administration, especially in the prehospital setting. Hypotension and tachycardia were indications of correct use. Although we did not observe a difference in VTE rates between the groups, though, our study was underpowered to detect a difference. Cautious implementation of TXA in resuscitation protocols is encouraged in the meantime. Nonetheless, adverse events associated with unjustified TXA administration should be further evaluated.
氨甲环酸（TXA）的早期给药已广泛用于治疗出血性休克中假定的纤维蛋白溶解亢进。我们旨在描述 TXA 的广泛使用情况，以及不合理的给药是否与静脉血栓栓塞事件（VTE）的增加有关。
我们通过查询我们的一级创伤中心的登记处，确定了在 2016 年 1 月至 2018 年 1 月期间接受 TXA 治疗的受伤患者。我们回顾性地审查了病历和影像学图像，以确定患者是否存在需要 TXA 治疗的出血性损伤（合理）或不需要（不合理）。
95 名患者因创伤性损伤接受了 TXA 治疗，其中 42.1%是由紧急医疗服务机构给予的。在回顾性研究中，35.8%的患者和在急救时给予 TXA 的患者被认为是不合理的。与不合理给药相比，合理组患者年龄更小（47.6 岁比 58.4 岁；P=0.02），在现场（收缩压：107±31 毫米汞柱比 137±32 毫米汞柱；P<0.001）和急诊室（收缩压：97±27 毫米汞柱比 128±27 毫米汞柱；P<0.001）的血压更低，在急诊室的心率更快（心率：99±29 次/分比 88±19 次/分；P=0.04）。合理组的损伤严重程度评分也更高（中位数 24 分比 11 分；P<0.001），更常输血（81.7%比 20.6%；P<0.001），院内死亡率更高（39.3%比 2.9%；P<0.001），但 VTE 发生率无差异（8.2%比 5.9%）。
我们的结果突出表明不合理给药的发生率很高，尤其是在院前环境中。低血压和心动过速是正确使用的指征。尽管我们没有观察到两组之间 VTE 发生率的差异，但我们的研究没有足够的能力来检测差异。在此期间，应谨慎实施 TXA 在复苏方案中的应用。尽管如此，仍应进一步评估不合理使用 TXA 相关的不良事件。
