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Area of Science:

  • Trauma care
  • Hemorrhage control
  • Critical care medicine

Background:

  • Tranexamic acid (TXA) is recommended for severely injured trauma patients.
  • The study investigated TXA's impact on fibrinolysis phenotypes and clinical outcomes.
  • A hypothesis proposed TXA increases multiple organ failure (MOF).

Purpose of the Study:

  • To examine the association between TXA administration, fibrinolysis phenotypes, and clinical outcomes in trauma patients.
  • To determine if TXA administration correlates with increased MOF.
  • To analyze TXA's effect on mortality and MOF across different fibrinolysis phenotypes.

Main Methods:

  • Retrospective, single-center study of 420 trauma patients (age ≥18, ISS >16).
  • Thromboelastography used to define fibrinolysis phenotypes: Shutdown (≤0.8% LY30), Physiologic (0.81-2.9% LY30), and Hyperfibrinolysis (≥3.0% LY30).
  • Outcomes assessed: 28-day mortality and MOF, analyzed with and without TXA across phenotypes.

Main Results:

  • No significant difference in 28-day mortality with TXA administration (P=0.52).
  • TXA significantly increased MOF (OR: 3.2, P<0.001), particularly in Shutdown (27.3%) and Hyperfibrinolysis (23.3%) phenotypes.
  • No increased MOF observed in the Physiologic phenotype (20.0% vs 7.7%, P=0.33).

Conclusions:

  • TXA administration in trauma patients is associated with increased MOF.
  • The association between TXA and MOF is pronounced in fibrinolysis shutdown and hyperfibrinolysis phenotypes.
  • Further research is needed to evaluate TXA's role in specific fibrinolysis profiles.