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Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury. J Trauma Acute Care Surg 2020 Nov;89(5):900-907

Date

10/27/2020

Pubmed ID

33105308

Pubmed Central ID

PMC7878849

DOI

10.1097/TA.0000000000002932

Scopus ID

2-s2.0-85092655592 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

BACKGROUND: No Food and Drug Administration-approved medication improves outcomes following traumatic brain injury (TBI). A forthcoming clinical trial that evaluated the effects of two prehospital tranexamic acid (TXA) dosing strategies compared with placebo demonstrated no differences in thromboelastography (TEG) values. We proposed to explore the impact of TXA on markers of coagulation and fibrinolysis in patients with moderate to severe TBI.

METHODS: Data were extracted from a placebo-controlled clinical trial in which patients 15 years or older with TBI (Glasgow Coma Scale, 3-12) and systolic blood pressure of ≥90 mm Hg were randomized prehospital to receive placebo bolus/placebo infusion (placebo), 1 g of TXA bolus/1 g of TXA infusion (bolus maintenance), or 2 g of TXA bolus/placebo infusion (bolus only). Thromboelastography was performed, and coagulation measures including prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, D-dimer, plasmin-antiplasmin (PAP), thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were quantified at admission and 6 hours later.

RESULTS: Of 966 patients receiving study drug, 700 had laboratory tests drawn at admission and 6 hours later. There were no statistically significant differences in TEG values, including LY30, between groups (p > 0.05). No differences between prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were demonstrated across treatment groups. Concentrations of D-dimer in TXA treatment groups were less than placebo at 6 hours (p < 0.001). Concentrations of PAP in TXA treatment groups were less than placebo on admission (p < 0.001) and 6 hours (p = 0.02). No differences in D-dimer and PAP were observed between bolus maintenance and bolus only.

CONCLUSION: While D-dimer and PAP levels reflect a lower degree of fibrinolysis following prehospital administration of TXA when compared with placebo in a large prehospital trial of patients with TBI, TEG obtained on admission and 6 hours later did not demonstrate any differences in fibrinolysis between the two TXA dosing regimens and placebo.

LEVEL OF EVIDENCE: Diagnostic test, level III.

Author List

Dixon AL, McCully BH, Rick EA, Dewey E, Farrell DH, Morrison LJ, McMullan J, Robinson BRH, Callum J, Tibbs B, Dries DJ, Jui J, Gandhi RR, Garrett JS, Weisfeldt ML, Wade CE, Aufderheide TP, Frascone RJ, Tallon JM, Kannas D, Williams C, Rowell SE, Schreiber MA

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Abbreviated Injury Scale
Adolescent
Adult
Antifibrinolytic Agents
Blood Coagulation
Blood Coagulation Disorders
Brain Injuries, Traumatic
Female
Fibrin Fibrinogen Degradation Products
Fibrinolysin
Fibrinolysis
Humans
Infusions, Intravenous
Injections, Intravenous
Male
Middle Aged
Thrombelastography
Time-to-Treatment
Tranexamic Acid
Treatment Outcome
Young Adult
alpha-2-Antiplasmin