Prehospital tranexamic acid is associated with a dose-dependent decrease in syndecan-1 after trauma: A secondary...

Area of Science:

• Trauma Care
• Vascular Biology
• Pharmacology

Background:

• The Study of Tranexamic Acid During Air and Ground Prehospital Transport (STAAMP) Trial indicated reduced mortality with prehospital tranexamic acid (TXA) in specific trauma subgroups.
• Mechanisms underlying TXA's benefits are not fully understood.
• This study investigated if TXA mitigates endothelial injury by assessing damage markers.

Purpose of the Study:

• To evaluate the association between prehospital TXA administration and markers of endothelial and tissue damage.
• To determine if TXA influences syndecan-1, soluble thrombomodulin (sTM), and platelet endothelial cell adhesion molecule-1 levels.

Main Methods:

• Blood samples were collected from 766 STAAMP Trial patients at multiple time points (0, 12, 24, 72 hours).
• Markers of endothelial function and tissue damage (syndecan-1, sTM) were measured.
• Regression analysis was used to model the relationship between TXA and marker concentrations, controlling for confounders.

Main Results:

• Lower levels of syndecan-1 and sTM within 72 hours of admission correlated with 30-day survival (p < 0.001).
• Syndecan-1 levels were significantly lower at hospital admission in the TXA group (p = 0.001).
• Increased TXA dosage was associated with decreased syndecan-1 levels at 12 hours (p = 0.03).

Conclusions:

• Prehospital TXA administration is associated with reduced syndecan-1 levels upon hospital admission.
• TXA's dose is inversely related to syndecan-1 levels measured 12 hours post-admission.
• Early TXA administration may reduce endothelial glycocalyx damage or enhance vascular repair mechanisms in a dose-dependent manner.