Impact of antifibrinolytic therapy on coagulopathy, induced by trauma and the traumatic disease course
Objective. To determine the efficacy of early administration of tranexamic acid to patients with traumatic injuries.
Маterials and methods. There were investigated the hemostasis system and the traumatic disease course through 72 h in 108 patients with multiple traumatic injuries. The patients were divided on two Groups, depending on the method of prophylaxis and complex correction used: Group I - 54 patients, who did not obtain antifibrinolytic preparations, Group II - 54 patients, to whom tranexamic acid was injected intravenously in a 1000 mg dose while hospitalization and 15 mg/kg every 6 h during 3 days. Instrumental and laboratory investigations were performed, as well as the patients’ general status estimation, constant monitoring of the vital functions indices, analysis of the diuresis value, the blood level dynamics of general creatininphosphokinase (CPHK) and hemoglobin, the need in hemotransfusion and duration of treatment in Department of Intensive Therapy (DІТ). Up to the admittance to DІТ the patients’ state in accordance to the Updated Scale of the Injuries Severity (NISS, New Injury Severity Score) was estimated as (28.34 ± 2.06) points.
Results. While admittance to hospital to DIT in the patients with traumatic injuries the thrombocytes aggregation raising with the vascular-thrombocytic hemostasis activation, hypocoagulation and significantly activated fibrinolysis were registered. In accordance to data of monitoring for the hemodynamics indices in all the patients there were registered the lowering of systolic arterial pressure (SАP), average arterial pressure (AvАP) and the shock index with the heart rate raising, what constitute the signs of traumatic shock, the sympato-adrenal system activation and the blood circulation centralization. In the patients of Group II a dynamics of the general CPHK level lowering was more severe, level of hemoglobin - constantly higher, so that’s why they needed hemotransfusion of erythrocytic mass in a much lesser volume, comparing with patients of the Group I, what may be connected with early administration of therapy for coagulopathy, induced by the trauma, and lowering of the blood loss.
Conclusion. The changes revealed witnesses, that administration of preparations from the fibrinolysis inhibitors group to the patients with traumatic injuries impacts positively on the fibrinolytic system indices, the traumatic disease course, normalizes the blood circulation, promotes the egress of patients from the traumatic shock state, lowers the necessity for hemotransfusion.
2. Nishida T, Kinoshita T, Yamakawa K. Tranexamic acid and trauma-induced coagulopathy. J Intensive care. 2017 Jan 20;5:5. doi: 10.1186/s40560-016-0201-0.
3. Roberts I Tranexamic acid in trauma: how should we use it? 2015; 13(1):S195-9. doi: 10.1111/jth.12878.
4. Deras P1, Villiet M, Manzanera J, Latry P, Schved JF, Capdevila X, Charbit J. Early coagulopathy at hospital admission predicts initial or delayed fibrinogen deficit in severe trauma patients. J Trauma Acute Care Surg. 2014 Sep;77(3):433-40. doi: 10.1097/TA.0000000000000314.
5. Floccard B, Rugeri L, Faure A, Saint Denis M, Boyle EM, Peguet O, et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 2012 Jan;43(1):26-32. doi: 10.1016/j.injury.2010.11.003.
This work is licensed under a Creative Commons Attribution 4.0 International License.