Clinical value of early pre-hospital application of tranexamic acid in trauma patients

doi:10.3877/cma.j.issn.2095-9133.2021.02.002

Abstract

Abstract:

Objective

To evaluate the changes of coagulation in trauma hemorrhagic patients from on-scene to the emergency department after tranexamic acid (TXA) application.

Methods

A total of of 118 trauma patients with trauma index (TI)≥Ie were enrolled in this study, including 91 males and 27 females with an average age of 43.9 (14-73) years. The patients were randomly divided into TXA group (n=59) and control group (n=59): the TXA group received tranexamic acid before hospital, which included 45 males and 14 females with an average age of 44.3 (14-73) years; the control group was not treated with tranexamic acid, which included 46 males and 13 females with an average age of 44.6 (17-73) years. The difference of coagulation tests and thromboelastogram was compared between on-scene and emergency department.

Results

There was no difference in epidemiology between the groups. Coagulation assays on-scene had no significant difference between the TXA group and the control group. There was no significant change of maximum amplitude of thromboelastogram (MA) and fibrinogen levels in TXA group from on-scene to emergency, but MA in the control group decreased (1.2±2.7) mm; differences were significant between the two groups (P<0.001). D-dimers as a fragment of fibrinogen production, in TXA group decreased significantly compared with the control group (P<0.05).

Conclusion

In patients with acute traumatic hemorrhage, early prehospital application of TXA can inhibit fibrinogen solubility, stabilize blood clots and reduce the production of D-dimers, which shows the value of clinical trauma treatment and prevention of traumatic coagulopathy.

Key words: pre-hospital, trauma, coagulation function, thromboelastogram, tranexamic acid

Tinglao Chen, Huisha Luo, Zhenxi Zhao, Meiling Xu, jinglun Wu. Clinical value of early pre-hospital application of tranexamic acid in trauma patients[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2021, 07(02): 74-78.

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Figures/Tables 5

References 21

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组别	例数	年龄(岁，±s)	性别[例(%)]		ISS评分[分，M(Q_L～Q_U)]	创伤部位[例(%)]				收缩压(mmHg，±s)	心率(次/分，±s)	休克指数[M(Q_L～Q_U)]	晶体液[mL, M(Q_L～Q_U)]	胶体液[mL, M(min～max)]
组别	例数	年龄(岁，±s)	男性	女性	ISS评分[分，M(Q_L～Q_U)]	头颈部	胸部	腹部	四肢	收缩压(mmHg，±s)	心率(次/分，±s)	休克指数[M(Q_L～Q_U)]	晶体液[mL, M(Q_L～Q_U)]	胶体液[mL, M(min～max)]
TXA组	59	44.3±15.2	45(76)	14(24)	17(13～38)	34(58)	7(12)	3(5)	15(25)	128±14	86±17	0.7(0.6～0.8)	500(250～500)	0(0～500)
对照组	59	43.6±14.6	46(78)	13(22)	17(13～43)	32(54)	9(15)	4(7)	14(24)	131±56	90±20	0.7(0.6～0.9)	500(250～500)	0(0～500)
t/χ²/z值		0.26	0.05		-0.63	0.49				-0.41	-1.22	-1.24	-0.69	-0.39
P值		>0.05	>0.05		>0.05	>0.05				>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	年龄(岁，±s)	性别[例(%)]		ISS评分[分，M(Q_L～Q_U)]	创伤部位[例(%)]				收缩压(mmHg，±s)	心率(次/分，±s)	休克指数[M(Q_L～Q_U)]	晶体液[mL, M(Q_L～Q_U)]	胶体液[mL, M(min～max)]
组别	例数	年龄(岁，±s)	男性	女性	ISS评分[分，M(Q_L～Q_U)]	头颈部	胸部	腹部	四肢	收缩压(mmHg，±s)	心率(次/分，±s)	休克指数[M(Q_L～Q_U)]	晶体液[mL, M(Q_L～Q_U)]	胶体液[mL, M(min～max)]
TXA组	59	44.3±15.2	45(76)	14(24)	17(13～38)	34(58)	7(12)	3(5)	15(25)	128±14	86±17	0.7(0.6～0.8)	500(250～500)	0(0～500)
对照组	59	43.6±14.6	46(78)	13(22)	17(13～43)	32(54)	9(15)	4(7)	14(24)	131±56	90±20	0.7(0.6～0.9)	500(250～500)	0(0～500)
t/χ²/z值		0.26	0.05		-0.63	0.49				-0.41	-1.22	-1.24	-0.69	-0.39
P值		>0.05	>0.05		>0.05	>0.05				>0.05	>0.05	>0.05	>0.05	>0.05

组别	PT(s)	APTT(s)	FBG(g/L)	DD(mg/L)	R(min)	K(min)	Angle(°)	MA(mm)	CI
TXA组	12.4(11.8～13.6)	25.9(21.8～35.2)	1.6(1.3～2.0)	6.2(3.0～10.0)	6.8(5.9～8.0)	1.8(1.4～2.3)	60.0(55.0～65.0)	60.0(56.0～66.0)	0.7(0.3～1.3)
对照组	12.5(11.7～14.7)	25.0(21.2～34.7)	1.6(1.2～2.0)	5.0(2.0～8.7)	6.8(5.9～8.2)	2.0(1.5～2.4)	63.0(58.0～65.0)	59.0(56.0～65.0)	0.6(0.1～1.3)
z值	-0.97	-0.66	-0.13	-1.76	-0.34	-0.88	-1.38	-1.15	-0.91
P值	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	PT(s)	APTT(s)	FBG(g/L)	DD(mg/L)	R(min)	K(min)	Angle(°)	MA(mm)	CI
TXA组	12.4(11.8～13.6)	25.9(21.8～35.2)	1.6(1.3～2.0)	6.2(3.0～10.0)	6.8(5.9～8.0)	1.8(1.4～2.3)	60.0(55.0～65.0)	60.0(56.0～66.0)	0.7(0.3～1.3)
对照组	12.5(11.7～14.7)	25.0(21.2～34.7)	1.6(1.2～2.0)	5.0(2.0～8.7)	6.8(5.9～8.2)	2.0(1.5～2.4)	63.0(58.0～65.0)	59.0(56.0～65.0)	0.6(0.1～1.3)
z值	-0.97	-0.66	-0.13	-1.76	-0.34	-0.88	-1.38	-1.15	-0.91
P值	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	PT(s)	APTT(s)	FBG(g/L)	DD(mg/L)	R(min)	K(min，±s)	Angle(°)	MA(mm，±s)	CI
TXA组	13.1(12.2～15.3)	31.7(24.9～45.3)	1.8(1.2～2.5)	8.6(3.9～12.0)	7.3(6.4～8.2)	1.9±0.5	60(57～65)	60.9±5.8	0.6(0.1～1.3)
对照组	13.1(12.4～15.3)	31.0(26.3～37.2)	1.9(1.3～3.1)	9.0(5.0～13.0)	7.3(6.4～8.2)	2.0±0.5	63(58～67)	57.9±6.1	0.6(0.1～1.3)
z/t值	-0.96	-0.65	-1.15	-0.71	-0.54	-0.90	-0.67	2.75	-0.08
P值	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05

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