Division of Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty, University of Zurich.
Department of Clinical studies, Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich.
Schweiz Arch Tierheilkd. 2022 Jun;164(6):437-446. doi: 10.17236/sat00357.
Tranexamic acid (TXA) is an antifibrinolytic drug used for the prophylaxis and treatment of haemorrhage of various origin. This retrospective study investigated the effect of TXA on ongoing bleeding in dogs with nonsurgically treated haemoabdomen. The study population consisted of 48 dogs treated in the period 2009-2020 at the Small Animal Clinic of the Vetsuisse Faculty of Zurich. Twenty-eight of 48 dogs were treated with 20 mg/kg TXA IV within 3h of diagnosis of haemoabdomen. Dogs treated with and without TXA were monitored over 48 hours for signs of ongoing haemorrhage. Ongoing haemorrhage was defined as an increase in abdominal fluid accumulation, a decrease in haematocrit of >5% over time or need for surgical exploration after at least 12 hours of medical treatment. Transfusion requirements, cumulative amount of fluid therapy, heart rate, respiratory rate, temperature, systolic and mean arterial pressure, estimate of abdominal fluid identified by FAST analysis, venous haematocrit, abdominal haematocrit, serum albumin, serum lactate and thrombocyte count were extracted from patient records at 6, 12, 24 and 48 hours after diagnosis of haemoabdomen. Groups were comparable at presentation, however dogs of the TXA group showed a significantly lower abdominal haematocrit at presentation (37 vs 45%, P=0,034) and a higher fluid accumulation (P=0,019), both persisting over time. None of the outcome parameters for ongoing haemorrhage was significantly different between groups. Transfusion requirement was low and similar in both groups. Of interest, none of the 16 dogs undergoing thromboelastometry showed hyperfibrinolysis at presentation. We conclude that other mechanisms than antifibrinolytic therapy was responsible for cessation of bleeding in the majority of patients.
氨甲环酸（TXA）是一种抗纤维蛋白溶解药物，用于预防和治疗各种来源的出血。本回顾性研究调查了 TXA 对非手术治疗性血腹犬持续性出血的影响。研究人群包括 2009 年至 2020 年在苏黎世兽医大学小动物诊所接受治疗的 48 只狗。48 只狗中有 28 只在诊断为血腹后 3 小时内接受了 20mg/kg 的 TXA IV 治疗。接受和未接受 TXA 治疗的狗在 48 小时内监测有无持续性出血迹象。持续性出血定义为腹部液体积聚增加、血细胞比容随时间下降超过 5%或在至少 12 小时的药物治疗后需要手术探查。在诊断为血腹后 6、12、24 和 48 小时，从患者记录中提取输血需求、累计液体治疗量、心率、呼吸频率、体温、收缩压和平均动脉压、通过 FAST 分析估计的腹部液体量、静脉血细胞比容、腹部血细胞比容、血清白蛋白、血清乳酸和血小板计数。两组在就诊时具有可比性，但 TXA 组就诊时的腹部血细胞比容明显较低（37%比 45%，P=0.034），且液体积聚较高（P=0.019），随时间推移持续存在。两组之间持续性出血的任何结局参数均无显著差异。输血需求低且两组相似。有趣的是，16 只接受血栓弹性描记术检查的狗在就诊时均未显示出高纤维蛋白溶解。我们得出结论，除了抗纤维蛋白溶解治疗外，还有其他机制导致大多数患者的出血停止。
