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Updated: May 10, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Coagulopathy as a predictor of the effectiveness of tranexamic acid in severe blunt trauma: a multicenter
Yuki Takahashi1, Mineji Hayakawa2,3, Yuki Itagaki1
1Emergency and Critical Care Center, Hokkaido University Hospital, North 14-West5, Kita- ku, Sapporo, 060-8648, Japan.
Background:
Tranexamic acid (TXA) reduces mortality in severe trauma cases. However, the relationships between TXA administration and coagulation/fibrinolysis abnormalities are unclear. We performed a retrospective observational study to investigate relationships between mortality and coagulation/fibrinolysis abnormalities of patients on arrival at the emergency department and whether TXA is more effective in patients with severe trauma who have coagulation/fibrinolysis abnormalities than in those who do not.
Methods:
Data was collected from 15 tertiary emergency and critical care centers in Japan. Adult patients with blunt trauma and an Injury Severity Score of ≥ 16 were included in the study. Patients were categorized into two groups: the TXA group received TXA within 3 h of arrival, and the non-TXA group did not.
Results:
Overall, 790 patients were included (TXA group, 276; non-TXA group, 514). In cubic spline curves for relationships between mortality and coagulation/fibrinolysis variables on arrival, odds for mortality increased and plateaued with a prothrombin time-international normalized ratio ≥ 1.2; the disseminated intravascular coagulation (DIC) score showed a marked odds increase when > 4 points. Odds increased and plateaued from an activated partial thromboplastin time (APTT) of ≥ 35 s and gradually increased as fibrinogen decreased from 250 mg/dL. Fibrinogen and fibrin degradation products (FDP) and D-dimer exhibited upward-sloping curves. In cubic spline curves for relationships between the effectiveness of TXA administration and coagulation/fibrinolysis variables on arrival, a favorable effect on mortality was observed with TXA administration when fibrinogen was ≤ 200 mg/dL or when the DIC score was ≥ 4 points; FDP, ≥ 50 µg/mL; D-dimer, ≥ 30 µg/mL; or APTT, ≥ 35 s. In each threshold subgroup, interactions between TXA administration and in-hospital mortality were observed.
Conclusions:
TXA demonstrates increased effectiveness in patients with traumatic coagulation/fibrinolysis abnormalities.
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