Safety and efficacy of thromboelastography guidance of antifibrinolytic therapy in trauma patients: An observational cohort analysis.
Antifibrinolytic agents
Injury Severity Score
thromboelastography
tranexamic acid
wounds and injuries
Journal
International journal of critical illness and injury science
ISSN: 2229-5151
Titre abrégé: Int J Crit Illn Inj Sci
Pays: India
ID NLM: 101571136
Informations de publication
Date de publication:
Historique:
received:
01
06
2020
revised:
24
10
2020
accepted:
01
01
2021
entrez:
16
8
2021
pubmed:
17
8
2021
medline:
17
8
2021
Statut:
ppublish
Résumé
Tranexamic acid (TXA) is an antifibrinolytic therapy intended to decrease blood loss and improve hemostasis in traumatic hemorrhage. Viscoelastic assays, such as thromboelastography (TEG), allow for the identification of a patient's specific hemostasis. The purpose of this research study was to explore the safety and efficacy of TEG-guided antifibrinolytic therapy in trauma patients. This study was a retrospective review of trauma patients meeting institution-specific inclusion criteria for TXA. Patients were assigned to fibrinolytic groups per TEG LY30 data. Safety outcomes (24-h mortality, overall in-hospital mortality, and thromboembolic events) were compared between patients who did or did not receive TXA and within fibrinolytic groups. Mortality outcomes were adjusted for baseline Injury Severity Score (ISS). Secondary aims included blood product utilization, length of hospital, and intensive care unit stay. Hypofibrinolysis was the most common fibrinolytic phenotype. Adjusting for ISS, there were no significant differences in mortality. A 30.7% thromboembolism incidence was identified in the TXA group compared to 16.6% not receiving TXA ( There were no differences in 24-h mortality, all-cause mortality, or secondary outcomes. The difference in thromboembolic rates between patients receiving TXA and those who did not, while not statistically significant, poses clinical concern.
Sections du résumé
BACKGROUND
BACKGROUND
Tranexamic acid (TXA) is an antifibrinolytic therapy intended to decrease blood loss and improve hemostasis in traumatic hemorrhage. Viscoelastic assays, such as thromboelastography (TEG), allow for the identification of a patient's specific hemostasis. The purpose of this research study was to explore the safety and efficacy of TEG-guided antifibrinolytic therapy in trauma patients.
METHODS
METHODS
This study was a retrospective review of trauma patients meeting institution-specific inclusion criteria for TXA. Patients were assigned to fibrinolytic groups per TEG LY30 data. Safety outcomes (24-h mortality, overall in-hospital mortality, and thromboembolic events) were compared between patients who did or did not receive TXA and within fibrinolytic groups. Mortality outcomes were adjusted for baseline Injury Severity Score (ISS). Secondary aims included blood product utilization, length of hospital, and intensive care unit stay.
RESULTS
RESULTS
Hypofibrinolysis was the most common fibrinolytic phenotype. Adjusting for ISS, there were no significant differences in mortality. A 30.7% thromboembolism incidence was identified in the TXA group compared to 16.6% not receiving TXA (
CONCLUSIONS
CONCLUSIONS
There were no differences in 24-h mortality, all-cause mortality, or secondary outcomes. The difference in thromboembolic rates between patients receiving TXA and those who did not, while not statistically significant, poses clinical concern.
Identifiants
pubmed: 34395207
doi: 10.4103/IJCIIS.IJCIIS_79_20
pii: IJCIIS-11-67
pmc: PMC8318174
doi:
Types de publication
Journal Article
Langues
eng
Pagination
67-72Informations de copyright
Copyright: © 2021 International Journal of Critical Illness and Injury Science.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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