Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury

Alexandra L. Dixon, Belinda H. McCully, Elizabeth A. Rick, Elizabeth Dewey, David H. Farrell, Laurie J. Morrison, Jason McMullan, Bryce R.H. Robinson, Jeannie Callum, Brian Tibbs, David J. Dries, Jonathan Jui, Rajesh R. Gandhi, John S. Garrett, Myron L. Weisfeldt, Charles E. Wade, Tom P. Aufderheide, Ralph J. Frascone, John M. Tallon, Delores KannasCarolyn Williams, Susan E. Rowell, Martin A. Schreiber

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND No Food and Drug Administration-approved medication improves outcomes following traumatic brain injury (TBI). A forthcoming clinical trial that evaluated the effects of two prehospital tranexamic acid (TXA) dosing strategies compared with placebo demonstrated no differences in thromboelastography (TEG) values. We proposed to explore the impact of TXA on markers of coagulation and fibrinolysis in patients with moderate to severe TBI. METHODS Data were extracted from a placebo-controlled clinical trial in which patients 15 years or older with TBI (Glasgow Coma Scale, 3-12) and systolic blood pressure of ≥90 mm Hg were randomized prehospital to receive placebo bolus/placebo infusion (placebo), 1 g of TXA bolus/1 g of TXA infusion (bolus maintenance), or 2 g of TXA bolus/placebo infusion (bolus only). Thromboelastography was performed, and coagulation measures including prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, D-dimer, plasmin-antiplasmin (PAP), thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were quantified at admission and 6 hours later. RESULTS Of 966 patients receiving study drug, 700 had laboratory tests drawn at admission and 6 hours later. There were no statistically significant differences in TEG values, including LY30, between groups (p > 0.05). No differences between prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were demonstrated across treatment groups. Concentrations of D-dimer in TXA treatment groups were less than placebo at 6 hours (p < 0.001). Concentrations of PAP in TXA treatment groups were less than placebo on admission (p < 0.001) and 6 hours (p = 0.02). No differences in D-dimer and PAP were observed between bolus maintenance and bolus only. CONCLUSION While D-dimer and PAP levels reflect a lower degree of fibrinolysis following prehospital administration of TXA when compared with placebo in a large prehospital trial of patients with TBI, TEG obtained on admission and 6 hours later did not demonstrate any differences in fibrinolysis between the two TXA dosing regimens and placebo. LEVEL OF EVIDENCE Diagnostic test, level III.

Original languageEnglish (US)
Pages (from-to)900-907
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume89
Issue number5
DOIs
StatePublished - Nov 1 2020

Keywords

  • Thromboelastography
  • conventional coagulation assays
  • fibrinolysis
  • tranexamic acid
  • traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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