Maegele Marc
Department for Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center (CMMC).
Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany.
Curr Opin Anaesthesiol. 2025 Apr 1;38(2):129-135. doi: 10.1097/ACO.0000000000001465. Epub 2025 Feb 14.
The treatment of patients with traumatic brain injury (TBI) with subsequently evolving hemostatic failure and hemorrhagic lesion progression remains challenging. New studies highlight windows of opportunity for treatment optimization.
Results from recent randomized studies suggest an earlier treatment with antifibrinolytic tranexamic acid at a higher initial bolus dose. There seems to be a new window of opportunity for the early prehospital use of thawed plasma. Viscoelastic-based goal-directed treatment strategies are still not delivered timely in most patients although a recent meta-analysis has confirmed a survival benefit with this approach.
Mortality in TBI with subsequent evolving hemostatic failure can be reduced through treatment optimization delivering early prehospital high-dose tranexamic acid and in-hospital goal-directed treatment algorithms to timely correct coagulopathy and restore hemostasis.
治疗创伤性脑损伤（TBI）患者，随后出现不断演变的止血功能衰竭和出血性病变进展仍然具有挑战性。新的研究突出了治疗优化的机会窗口。
近期随机研究结果表明，以更高的初始推注剂量更早地使用抗纤维蛋白溶解剂氨甲环酸进行治疗。对于早期院前使用解冻血浆似乎有一个新的机会窗口。基于粘弹性的目标导向治疗策略在大多数患者中仍未及时实施，尽管最近的一项荟萃分析证实了这种方法对生存有益。
通过优化治疗，即早期院前给予高剂量氨甲环酸以及院内目标导向治疗算法，以及时纠正凝血病并恢复止血，可以降低随后出现不断演变的止血功能衰竭的TBI患者的死亡率。
