Abstract
Objective: To evaluate the effect of early tranexamic acid (TXA) administration on circulating markers of endotheliopathy. Setting: Twenty trauma centers in the United States and Canada. Participants: Patients with moderate-to-severe traumatic brain injury (TBI) (MS-TBI) and intracranial hemorrhage who were not in shock (systolic blood pressure ≥90 mm Hg). Design: TXA (2 g) or placebo administered prior to hospital arrival, less than 2 hours postinjury. Blood samples and head computed tomographic scan collected upon arrival. Plasma markers measured using Luminex analyte platform. Differences in median marker levels evaluated using t tests performed on log-transformed variables. Comparison groups were TXA versus placebo and less than 45 minutes versus 45 minutes or more from time of injury to treatment administration. Main Measures: Plasma levels of angiopoietin-1, angiopoietin-2, syndecan-1, thrombomodulin, thrombospondin-2, intercellular adhesion molecule 1, vascular adhesion molecule 1. Results: Demographics and Injury Severity Score were similar between the placebo (n = 129) and TXA (n = 158) groups. Levels of syndecan-1 were lower in the TXA group (median [interquartile range or IQR] = 254.6 pg/mL [200.7-322.0] vs 272.4 pg/mL [219.7-373.1], P =.05. Patients who received TXA less than 45 minutes postinjury had significantly lower levels of angiopoietin-2 (median [IQR] = 144.3 pg/mL [94.0-174.3] vs 154.6 pg/mL [110.4-209.8], P =.05). No differences were observed in remaining markers. Conclusions: TXA may inhibit early upregulation of syndecan-1 and angiopoietin-2 in patients with MS-TBI, suggesting attenuation of protease-mediated vascular glycocalyx breakdown. The findings of this exploratory analysis should be considered preliminary and require confirmation in future studies.
Original language | English (US) |
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Pages (from-to) | 317-323 |
Number of pages | 7 |
Journal | Journal of Head Trauma Rehabilitation |
Volume | 35 |
Issue number | 5 |
DOIs | |
State | Published - Sep 1 2020 |
Keywords
- angiopoietin-2
- brain injuries
- cell adhesion molecules
- craniocerebral trauma
- endothelium
- extracellular matrix proteins
- glycocalyx
- intracranial hemorrhages
- syndecan-1
- tranexamic acid
- traumatic
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
- Rehabilitation
- Clinical Neurology