Hunter B Moore1, Ernest E Moore2, Benjamin R Huebner3, Gregory R Stettler3, Geoffrey R Nunns3, Peter M Einersen3, Christopher C Silliman4, Angela Sauaia5. 1. Department of Surgery, University of Colorado Denver, Aurora, Colorado. Electronic address: hunter.moore@ucdenver.edu. 2. Department of Surgery, University of Colorado Denver, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado. 3. Department of Surgery, University of Colorado Denver, Aurora, Colorado. 4. Department of Surgery, University of Colorado Denver, Aurora, Colorado; Research Laboratory Bonfils Blood Center, Denver, Colorado. 5. Department of Surgery, University of Colorado Denver, Aurora, Colorado; University of Colorado School of Public Health, Aurora, Colorado.
Abstract
BACKGROUND: Tranexamic acid (TXA) administration after trauma has not been proven to improve survival in the United States. Trauma patients were presented to the hospital with a spectrum of fibrinolytic activity, in which physiological levels of fibrinolysis are associated with the lowest mortality. We hypothesize that trauma patients who present to the hospital with physiological levels of fibrinolysis will have increased mortality if they receive TXA. MATERIALS AND METHODS: Severely injured trauma patients, followed prospectively from 2014 to 2016, were included in the analysis. The patient's first thrombelastography was used to stratify patients into fibrinolysis phenotypes which included fibrinolysis shutdown, physiological fibrinolysis, and systemic hyperfibrinolysis. The primary outcome was in-hospital mortality. RESULTS: A total of 232 patients were analyzed (11% received TXA) with an overall mortality rate of 20%. TXA administration was associated with a higher new injury severity score (49 versus 28; P = 0.001), massive transfusion rate (69% versus 12%; P < 0.001), and mortality (52% versus 17%; P < 0.001). Hyperfibrinolysis and shutdown had higher mortality rates than physiological group (24% versus 30% versus 14%; P = 0.050). The effect of TXA within phenotypes was not significant for shutdown (28% versus 38%; P = 0.604) but was significant in the physiological group (11% versus 63%; P < 0.001) and systemic hyperfibrinolysis (19% versus 55%; P = 0.023). After adjusting for new injury severity score, TXA remained a significant predictor of mortality for patients with physiological fibrinolysis (P = 0.018). CONCLUSIONS: There was no clear benefit of receiving TXA in this study, and patients who present to the hospital with physiologic levels of fibrinolysis, who received TXA, had the highest mortality. The role of TXA in mature trauma systems remains unclear, and emerging data supports it may have adverse effects.
BACKGROUND:Tranexamic acid (TXA) administration after trauma has not been proven to improve survival in the United States. Traumapatients were presented to the hospital with a spectrum of fibrinolytic activity, in which physiological levels of fibrinolysis are associated with the lowest mortality. We hypothesize that traumapatients who present to the hospital with physiological levels of fibrinolysis will have increased mortality if they receive TXA. MATERIALS AND METHODS: Severely injured traumapatients, followed prospectively from 2014 to 2016, were included in the analysis. The patient's first thrombelastography was used to stratify patients into fibrinolysis phenotypes which included fibrinolysis shutdown, physiological fibrinolysis, and systemic hyperfibrinolysis. The primary outcome was in-hospital mortality. RESULTS: A total of 232 patients were analyzed (11% received TXA) with an overall mortality rate of 20%. TXA administration was associated with a higher new injury severity score (49 versus 28; P = 0.001), massive transfusion rate (69% versus 12%; P < 0.001), and mortality (52% versus 17%; P < 0.001). Hyperfibrinolysis and shutdown had higher mortality rates than physiological group (24% versus 30% versus 14%; P = 0.050). The effect of TXA within phenotypes was not significant for shutdown (28% versus 38%; P = 0.604) but was significant in the physiological group (11% versus 63%; P < 0.001) and systemic hyperfibrinolysis (19% versus 55%; P = 0.023). After adjusting for new injury severity score, TXA remained a significant predictor of mortality for patients with physiological fibrinolysis (P = 0.018). CONCLUSIONS: There was no clear benefit of receiving TXA in this study, and patients who present to the hospital with physiologic levels of fibrinolysis, who received TXA, had the highest mortality. The role of TXA in mature trauma systems remains unclear, and emerging data supports it may have adverse effects.
Authors: Ernest E Moore; Hunter B Moore; Eduardo Gonzalez; Angela Sauaia; Anirban Banerjee; Christopher C Silliman Journal: Transfusion Date: 2016-04 Impact factor: 3.157
Authors: Jonathan P Meizoso; Charles A Karcutskie; Juliet J Ray; Nicholas Namias; Carl I Schulman; Kenneth G Proctor Journal: J Am Coll Surg Date: 2016-12-23 Impact factor: 6.113
Authors: Angelo D'Alessandro; Hunter B Moore; Ernest E Moore; Matthew J Wither; Travis Nemkov; Alexander P Morton; Eduardo Gonzalez; Michael P Chapman; Miguel Fragoso; Anne Slaughter; Angela Sauaia; Christopher C Silliman; Kirk C Hansen; Anirban Banerjee Journal: Shock Date: 2016-08 Impact factor: 3.454
Authors: Michael P Chapman; Ernest E Moore; Christopher R Ramos; Arsen Ghasabyan; Jeffrey N Harr; Theresa L Chin; John R Stringham; Angela Sauaia; Christopher C Silliman; Anirban Banerjee Journal: J Trauma Acute Care Surg Date: 2013-12 Impact factor: 3.313
Authors: Bryan A Cotton; John A Harvin; Vadim Kostousouv; Kristin M Minei; Zayde A Radwan; Herbert Schöchl; Charles E Wade; John B Holcomb; Nena Matijevic Journal: J Trauma Acute Care Surg Date: 2012-08 Impact factor: 3.313
Authors: Borja Barrachina; Amanda Lopez-Picado; Maria Remon; Ana Fondarella; Ibai Iriarte; Rebeca Bastida; Alicia Rodríguez-Gascón; Maria Aranzazu Achaerandio; Maria Carmen Iturricastillo; Felipe Aizpuru; Cesar Augusto Valero; Ricardo Tobalina; Roberto Hernanz Journal: Anesth Analg Date: 2016-04 Impact factor: 5.108
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Daniela Filipescu; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund A M Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2016-04-12 Impact factor: 9.097
Authors: Hunter B Moore; Ernest E Moore; Matthew D Neal; Forest R Sheppard; Lucy Z Kornblith; Dominik F Draxler; Mark Walsh; Robert L Medcalf; Mitch J Cohen; Bryan A Cotton; Scott G Thomas; Christine M Leeper; Barbara A Gaines; Angela Sauaia Journal: Anesth Analg Date: 2019-09 Impact factor: 5.108
Authors: Gregory R Stettler; Ernest E Moore; Hunter B Moore; Geoffrey R Nunns; Christopher C Silliman; Anirban Banerjee; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2019-04 Impact factor: 3.313
Authors: Hunter B Moore; Ernest E Moore; Michael P Chapman; Kirk C Hansen; Mitchell J Cohen; Frederic M Pieracci; James Chandler; Angela Sauaia Journal: J Am Coll Surg Date: 2019-03-29 Impact factor: 6.113
Authors: Muhammad Khan; Faisal Jehan; Eileen M Bulger; Terence OʼKeeffe; John B Holcomb; Charles E Wade; Martin A Schreiber; Bellal Joseph Journal: J Trauma Acute Care Surg Date: 2018-11 Impact factor: 3.313
Authors: Jessica C Cardenas; Charles E Wade; Bryan A Cotton; Mitchell J George; John B Holcomb; Martin A Schreiber; Nathan J White Journal: Shock Date: 2019-03 Impact factor: 3.454
Authors: Ernest E Moore; Hunter B Moore; Michael P Chapman; Eduardo Gonzalez; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2018-06 Impact factor: 3.313
Authors: Navin G Vigneshwar; Ernest E Moore; Hunter B Moore; Bryan A Cotton; John B Holcomb; Mitchell J Cohen; Angela Sauaia Journal: Ann Surg Date: 2022-03-01 Impact factor: 12.969
Authors: Francis X Guyette; Joshua B Brown; Mazen S Zenati; Barbara J Early-Young; Peter W Adams; Brian J Eastridge; Raminder Nirula; Gary A Vercruysse; Terence O'Keeffe; Bellal Joseph; Louis H Alarcon; Clifton W Callaway; Brian S Zuckerbraun; Matthew D Neal; Raquel M Forsythe; Matthew R Rosengart; Timothy R Billiar; Donald M Yealy; Andrew B Peitzman; Jason L Sperry Journal: JAMA Surg Date: 2020-10-05 Impact factor: 14.766