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. 2021 Apr-Jun;11(2):67-72.
doi: 10.4103/IJCIIS.IJCIIS_79_20. Epub 2021 Jun 29.

Safety and efficacy of thromboelastography guidance of antifibrinolytic therapy in trauma patients: An observational cohort analysis

Rachel N Heilbronner  1 , Michelle Kincaid  2 , Grant Walliser  3 , Michelle Pershing  4 , M Chance Spalding  2
Affiliations

Safety and efficacy of thromboelastography guidance of antifibrinolytic therapy in trauma patients: An observational cohort analysis

Rachel N Heilbronner et al. Int J Crit Illn Inj Sci. 2021 Apr-Jun.

Abstract

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: 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: 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 (P = 0.26), with 72.7% of these patients experiencing fibrinolytic shutdown.

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.

Keywords: Antifibrinolytic agents; Injury Severity Score; thromboelastography; tranexamic acid; wounds and injuries.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the study population. We included a total of 55 patients in this study. We divided the patients into six groups determined by fibrinolytic phenotype per TEG LY30% data and TXA administration. There were 33 patients (60%) in the hypofibrinolytic group, 6 received TXA. There were 14 patients (25.5%) in the physiologically fibrinolytic group, 2 received TXA. There were 8 patients (14.5%) in the hyperfibrinolytic group, 5 received TXA. TXA: Tranexamic acid, TEG: Thromboelastography
Figure 2
Figure 2
Twenty-four-hour mortality among fibrinolytic phenotypes was not significantly different. Incidence of 24-h mortality was numerically higher among patient groups not receiving TXA. TXA: Tranexamic acid
Figure 3
Figure 3
Twenty-four-hour mortality was not significantly different between fibrinolytic phenotypes regardless of TXA administration. TXA: Tranexamic acid
Figure 4
Figure 4
Incidence of thromboembolism was not significantly different between two groups (P= 0.26). Thromboembolism was clinically more prevalent in patients receiving TXA. Fibrinolytic shutdown was the most common phenotype among patients who experienced thromboembolism. TXA: Tranexamic acid
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References

    1. Huang F, Wu D, Ma G, Yin Z, Wang Q. The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: A meta-analysis. J Surg Res. 2014;186:318–27. - PubMed
    1. Winter SF, Santaguida C, Wong F, Fehlings MG. Systemic and topical use of tranexamic acid in spinal surgery: A systematic review. Global Spine J. 2016;6:284–95. - PMC - PubMed
    1. Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): A randomized, placebo-controlled trial. Lancet. 2010;376:23–32. - PubMed
    1. Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev. 2012;26:1–13. - PubMed
    1. Abdelfattah K, Cripps MW. Thromboelastography and rotational thromboelastometry use in trauma. Int J Surg. 2016;33:196–201. - PubMed