Coagulation management: prehospital tranexamic acid. Pro and contra

被引：4

作者：

Lier, H. ^{[1
,2
]}

Maegele, M. ^{[3
]}

机构：

[1] Univ Klinikum Koln AoR, Klin Anasthesiol & Operat Intensivmed, Kerpener Str 62, D-50937 Cologne, Germany

[2] Deutsch Interdisziplinare Vereinigung Intensiv &, Sekt Hamotherapie & Hamostasemanagement, Berlin, Germany

[3] Univ Witten Herdecke, Klinikum Koln Merheim, Abt Unfallchirurg Orthopadie & Sporttraumatol, Ostmerheimerstr 200, D-51109 Cologne, Germany

来源：

NOTFALL & RETTUNGSMEDIZIN | 2019年 / 22卷 / 08期

关键词：

Multiple trauma; Fibrinolysis; Blood coagulation; Prehospital emergency care; Antifibrinolytic agents; FIBRINOLYSIS SHUTDOWN; TRAUMA PATIENTS; POSTINJURY FIBRINOLYSIS; MILITARY USE; HYPERFIBRINOLYSIS; RESUSCITATION; MORTALITY; INJURY; COAGULOPATHY; HEMORRHAGE;

D O I：

10.1007/s10049-018-0471-2

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

The use of tranexamic acid (TXA), an antifibrinolytic drug, has received increasing attention in the coagulation management of severely injured patients. Based on the results of the prospective, multicenter Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage-2 (CRASH-2) study with 20,211 patients, European experts were fairly quick to give high grading recommendations for TXA. However, the transferability of these results to modern trauma systems remains questionable and is doubted by some studies. Growing knowledge of trauma-induced coagulopathy with different phenotypes also impedes the universal application of TXA for all trauma patients. TXA is a medication; therefore, it requires an indication and has effects but also side effects. Especially in severely injured patients, TXA's current target population, some recent publications find a decreased mortality but increased thromboembolic effects. Only after evaluation of the results of current trials are evidence-based recommendations for prehospital application of TXA possible.

引用

页码：685 / 695

页数：11

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