凝血功能障碍作为氨甲环酸治疗严重钝性创伤有效性的预测指标：一项多中心回顾性研究

Coagulopathy as a predictor of the effectiveness of tranexamic acid in severe blunt trauma: a multicenter retrospective study.

作者信息

Takahashi Yuki, Hayakawa Mineji, Itagaki Yuki, Ono Kota, Kudo Daisuke, Kushimoto Shigeki

机构信息

Emergency and Critical Care Center, Hokkaido University Hospital, North 14-West5, Kita- ku, Sapporo, 060-8648, Japan.

Department Emergency and General Medicine, Sapporo City General Hospital, Chuo-Ku, N11W13, 060-8604, Sapporo, Japan.

出版信息

Thromb J. 2025 Apr 22;23(1):37. doi: 10.1186/s12959-025-00723-x.

DOI:10.1186/s12959-025-00723-x

PMID:40264127

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12013063/

Abstract

BACKGROUND

Tranexamic acid (TXA) reduces mortality in severe trauma cases. However, the relationships between TXA administration and coagulation/fibrinolysis abnormalities are unclear. We performed a retrospective observational study to investigate relationships between mortality and coagulation/fibrinolysis abnormalities of patients on arrival at the emergency department and whether TXA is more effective in patients with severe trauma who have coagulation/fibrinolysis abnormalities than in those who do not.

METHODS

Data was collected from 15 tertiary emergency and critical care centers in Japan. Adult patients with blunt trauma and an Injury Severity Score of ≥ 16 were included in the study. Patients were categorized into two groups: the TXA group received TXA within 3 h of arrival, and the non-TXA group did not.

RESULTS

Overall, 790 patients were included (TXA group, 276; non-TXA group, 514). In cubic spline curves for relationships between mortality and coagulation/fibrinolysis variables on arrival, odds for mortality increased and plateaued with a prothrombin time-international normalized ratio ≥ 1.2; the disseminated intravascular coagulation (DIC) score showed a marked odds increase when > 4 points. Odds increased and plateaued from an activated partial thromboplastin time (APTT) of ≥ 35 s and gradually increased as fibrinogen decreased from 250 mg/dL. Fibrinogen and fibrin degradation products (FDP) and D-dimer exhibited upward-sloping curves. In cubic spline curves for relationships between the effectiveness of TXA administration and coagulation/fibrinolysis variables on arrival, a favorable effect on mortality was observed with TXA administration when fibrinogen was ≤ 200 mg/dL or when the DIC score was ≥ 4 points; FDP, ≥ 50 µg/mL; D-dimer, ≥ 30 µg/mL; or APTT, ≥ 35 s. In each threshold subgroup, interactions between TXA administration and in-hospital mortality were observed.

CONCLUSIONS

TXA demonstrates increased effectiveness in patients with traumatic coagulation/fibrinolysis abnormalities.

摘要

背景

氨甲环酸（TXA）可降低严重创伤病例的死亡率。然而，TXA给药与凝血/纤维蛋白溶解异常之间的关系尚不清楚。我们进行了一项回顾性观察研究，以调查急诊科患者到达时死亡率与凝血/纤维蛋白溶解异常之间的关系，以及TXA在有凝血/纤维蛋白溶解异常的严重创伤患者中是否比没有异常的患者更有效。

方法

从日本15个三级急诊和重症监护中心收集数据。纳入钝性创伤且损伤严重程度评分≥16的成年患者。患者分为两组：TXA组在到达后3小时内接受TXA治疗，非TXA组未接受。

结果

总体而言，共纳入790例患者（TXA组276例；非TXA组514例）。在到达时死亡率与凝血/纤维蛋白溶解变量关系的三次样条曲线中，当凝血酶原时间-国际标准化比值≥1.2时，死亡几率增加并趋于平稳；当弥散性血管内凝血（DIC）评分>4分时，死亡几率显著增加。从活化部分凝血活酶时间（APTT）≥35秒开始，死亡几率增加并趋于平稳，随着纤维蛋白原从250mg/dL下降，死亡几率逐渐增加。纤维蛋白原、纤维蛋白降解产物（FDP）和D-二聚体呈现上升曲线。在TXA给药有效性与到达时凝血/纤维蛋白溶解变量关系的三次样条曲线中，当纤维蛋白原≤200mg/dL或DIC评分≥4分；FDP≥50μg/mL；D-二聚体≥30μg/mL；或APTT≥35秒时，TXA给药对死亡率有有利影响。在每个阈值亚组中，观察到TXA给药与院内死亡率之间的相互作用。