Prehospital tranexamic acid is associated with a dose-dependent decrease in syndecan-1 after trauma: A secondary analysis of a prospective randomized trial.
Prehospital tranexamic acid is associated with a dose-dependent decrease in syndecan-1 after trauma: A secondary analysis of a prospective randomized trial.
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DOI：
10.1097/ta.0000000000003955
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发表时间：
2023-11-01
期刊：
影响因子：
--
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中科院分区：
文献类型：
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院前TXA与循环syndecan-1浓度的剂量依赖性降低相关，提示其具有促内皮治疗作用。在空气和地面院前运输（STAAMP）试验中，院前氨甲环酸（TXA）与特定患者亚组中较低的死亡率相关。TXA益处的潜在机制尚未完全确定。我们假设TXA可能减轻内皮损伤，并试图评估在STAAMP试验中所有患者中TXA是否与内皮或组织损伤标志物降低有关。我们收集了STAAMP试验患者的血液样本，并在入院（0小时）和入院后12小时、24小时和72小时测量了内皮功能和组织损伤的标志物，包括syndecan-1、可溶性血栓调节蛋白（sTM）和血小板内皮细胞粘附分子-1。我们比较了每个治疗组患者在最初72小时内的这些标志物值，并使用回归分析模拟了TXA和标志物浓度之间的关系，以控制潜在的混杂因素。我们分析了来自766例患者的样本：383例安慰剂，130例缩短给药，119例标准给药，130例重复给药。入院前72小时内测量的syndecan-1、TM和血小板内皮细胞粘附分子水平较低与30天生存率相关（p < 0.001）。入院时，TXA组的syndecan-1较低（28.30[20.05,42.75]比33.50 [23.00,54.00]p = 0.001），即使控制了患者、损伤和院前因素（p = 0.001）。在院前转运和入院的前8小时内，TXA每增加1 g，在控制患者、损伤和治疗因素的12小时内，syndecan-1降低4 ng/mL （p = 0.03）。院前TXA与入院时syndecan-1降低有关。入院后12小时测量Syndecan-1与接受的TXA剂量呈负相关。院前和院内早期的TXA可能以剂量依赖的方式减少内皮糖萼损伤或上调血管修复机制。治疗和护理管理;第三层次。
Prehospital TXA was associated with a dose-dependent decrease in circulating syndecan-1 concentrations suggesting a pro-endothelial therapeutic effect. In the Study of Tranexamic Acid During Air and Ground Prehospital Transport (STAAMP) Trial, prehospital tranexamic acid (TXA) was associated with lower mortality in specific patient subgroups. The underlying mechanisms responsible for a TXA benefit remain incompletely characterized. We hypothesized that TXA may mitigate endothelial injury and sought to assess whether TXA was associated with decreased endothelial or tissue damage markers among all patients enrolled in the STAAMP Trial. We collected blood samples from STAAMP Trial patients and measured markers of endothelial function and tissue damage including syndecan-1, soluble thrombomodulin (sTM), and platelet endothelial cell adhesion molecule-1 at hospital admission (0 hours) and 12 hours, 24 hours, and 72 hours after admission. We compared these marker values for patients in each treatment group during the first 72 hours, and modeled the relationship between TXA and marker concentration using regression analysis to control for potential confounding factors. We analyzed samples from 766 patients: 383 placebo, 130 abbreviated dosing, 119 standard dosing, and 130 repeat dosing. Lower levels of syndecan-1, TM, and platelet endothelial cell adhesion molecule measured within the first 72 hours of hospital admission were associated with survival at 30 days (p < 0.001). At hospital admission, syndecan-1 was lower in the TXA group (28.30 [20.05, 42.75] vs. 33.50 [23.00, 54.00] p = 0.001) even after controlling for patient, injury, and prehospital factors (p = 0.001). For every 1 g increase in TXA administered over the first 8 hours of prehospital transport and hospital admission, there was a 4-ng/mL decrease in syndecan-1 at 12 hours controlling for patient, injury, and treatment factors (p = 0.03). Prehospital TXA was associated with decreased syndecan-1 at hospital admission. Syndecan-1 measured 12 hours after admission was inversely related to the dose of TXA received. Early prehospital and in-hospital TXA may decrease endothelial glycocalyx damage or upregulate vascular repair mechanisms in a dose-dependent fashion. Therapeutic/Care Management; Level III.
影响因子：
3.7
作者：
Vigstedt M;Søe-Jensen P;Bestle MH;Clausen NE;Kristiansen KT;Lange T;Stensballe J;Perner A;Johansson PI
通讯作者：
Johansson PI