Effectiveness of early administration of tranexamic acid in patients with severe trauma.
Effectiveness of early administration of tranexamic acid in patients with severe trauma.
复制标题
严重创伤患者早期给予氨甲环酸的有效性。
DOI：
10.1002/bjs.10497
复制
发表时间：
2017
影响因子：
9.6
通讯作者：
Murata K; Japanese Observational Study for Coagulation and Thrombolysis in Early Trauma (J-OCTET) investigators.
中科院分区：
文献类型：
--
作者：
Shiraishi A;Kushimoto S;Otomo Y;Matsui H;Hagiwara A;Murata K; Japanese Observational Study for Coagulation and Thrombolysis in Early Trauma (J-OCTET) investigators.
研究背景：早期使用氨甲环酸可降低严重受伤出血患者的死亡率。然而，这种没有减少输血的适度治疗效果引起了人们的关注。本研究的目的是评估常规使用氨甲环酸对严重损伤患者的有效性。方法本多中心观察性研究回顾性收集了2012年在日本15家学术机构治疗的连续受伤患者（损伤严重程度评分至少为16分）的数据。倾向评分匹配分析比较了在受伤后3小时内接受或未接受氨甲环酸治疗的患者。研究结果包括28天全因死亡率和特定原因死亡率，以及输血需求。结果796例符合条件的受试者中，281例接受氨甲环酸治疗。倾向评分匹配共选择500名匹配对象（每组250人）。氨甲环酸给药可降低28天死亡率（10.0% vs . 18.4%；差异为8.4% (95% vs . - 14.5% ~ - 2.3%)）和原发性脑损伤28天死亡率（6.0% vs . 13.2%；差异为7.2%(- 12.3% ~ - 2.1%)）。然而，输血需求在两组之间没有显著差异（33.2%对34.8%；差异- 1.6%(- 9.9%到6.7%)）。结论早期使用氨甲环酸可降低严重颅脑损伤患者的死亡率，尤其是原发性脑损伤患者。
BackgroundA reduction in mortality with the early use of tranexamic acid has been demonstrated in severely injured patients who are bleeding. However, the modest treatment effect with no reduction in blood transfusion has raised concerns. The aim of the present study was to estimate the effectiveness of regular use of tranexamic acid in severely injured patients.MethodsThis multicentre observational study used retrospectively collected data from consecutive injured patients (Injury Severity Score at least 16) treated in 15 Japanese academic institutions in 2012. A propensity score-matched analysis compared patients who did or did not receive tranexamic acid administration within 3 h of injury. Study outcomes included 28-day all-cause and cause-specific mortality, and need for blood transfusion.ResultsOf 796 eligible subjects, 281 were treated with tranexamic acid. Propensity score matching selected a total of 500 matched subjects (250 in each group). Tranexamic acid administration was associated with lower 28-day mortality (10·0versus18·4 per cent; difference −8·4 (95 per cent c.i. –14·5 to −2·3) per cent) and lower 28-day mortality from primary brain injury (6·0versus13·2 per cent; difference −7·2 (−12·3 to −2·1) per cent). However, there was no significant difference between groups in the need for blood transfusion (33·2versus34·8 per cent; difference −1·6 (−9·9 to 6·7) per cent).ConclusionEarly tranexamic acid use was associated with reduced mortality in severely injured patients, in particular those with a primary brain injury.