Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial.

IF 1 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2025-01-01 Epub Date: 2024-08-07 DOI:10.1177/00031348241268109

Shariq S Raza, Danielle Tatum, Kristen D Nordham, Jacob M Broome, Jane Keating, Zoe Maher, Amy J Goldberg, Grace Chang, Michelle Mendiola Pla, Elliott R Haut, Leah Tatebe, Eman Toraih, Christofer Anderson, Scott Ninokawa, Patrick Maluso, Sigrid Burruss, Matthew Reeves, Lauren E Coleman, David V Shatz, Anna Goldenberg-Sandau, Apoorva Bhupathi, Chance Spalding, Aimee LaRiccia, Emily Bird, Matthew R Noorbakhsh, James Babowice, Marsha C Nelson, Lewis E Jacobson, Jamie Williams, Michael Vella, Kate Dellonte, Thomas Z Hayward, Emma Holler, Mark J Lieser, John D Berne, Dalier R Mederos, Reza Askari, Barbara Okafor, Eric Etchill, Raymond Fang, Samantha L Roche, Laura Whittenburg, Andrew C Bernard, James M Haan, Kelly L Lightwine, Scott H Norwood, Jason Murry, Mark A Gamber, Matthew M Carrick, Nikolay Bugaev, Antony Tatar, Juan Duchesne, Sharven Taghavi

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引用次数: 0

Abstract

Background: Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients.

Materials and methods: This is a post-hoc analysis of a multicenter, prospective, observational study of adults (18+ years) with penetrating torso and/or proximal extremity injury presenting at 25 urban trauma centers. Tranexamic acid administration in the prehospital setting or within three hours of admission was examined. Participants were propensity matched to compare similarly injured patients. The primary outcome was development of pulmonary complication (ARDS and/or pneumonia).

Results: A total of 2382 patients were included, and 206 (8.6%) received TXA. Of the 206, 93 (45%) received TXA prehospital and 113 (55%) received it within three hours of hospital admission. Age, sex, and incidence of massive transfusion did not differ. The TXA group was more severely injured, more frequently presented in shock (SBP < 90 mmHg), developed more pulmonary complications, and had lower survival (P < 0.01 for all). After propensity matching, 410 patients remained (205 in each cohort) with no difference in age, sex, or rate of shock. On logistic regression, increased emergency department heart rate was associated with pulmonary complications. Tranexamic acid was not associated with different rate of pulmonary complications or survival on logistic regression. Survival was not different between the groups on logistic regression or propensity score-matched analysis.

Conclusions: Tranexamic acid administration is not protective against pulmonary complications in penetrating trauma patients.

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氨甲环酸与肺部并发症：EAST 多中心试验的二次分析。

背景：氨甲环酸（TXA）在减轻创伤内皮细胞病变方面的抗炎作用可防止急性肺损伤。目前尚无临床数据显示创伤患者可从中获益。我们假设氨甲环酸能减轻穿透性创伤患者的肺部并发症：这是一项多中心、前瞻性、观察性研究的事后分析，研究对象是在 25 个城市创伤中心就诊的穿透性躯干和/或四肢近端损伤的成人（18 岁以上）。研究人员对院前或入院三小时内的氨甲环酸用药情况进行了检查。对参与者进行了倾向匹配，以比较类似的受伤患者。主要结果是出现肺部并发症（ARDS和/或肺炎）：共纳入 2382 名患者，其中 206 人（8.6%）接受了 TXA 治疗。在这 206 名患者中，93 人（45%）在院前接受了 TXA，113 人（55%）在入院三小时内接受了 TXA。年龄、性别和大量输血的发生率没有差异。TXA 组患者伤势更严重，更常出现休克（SBP < 90 mmHg），出现更多肺部并发症，存活率更低（P < 0.01）。经过倾向匹配后，剩下的 410 名患者（每组 205 人）在年龄、性别或休克率方面没有差异。根据逻辑回归，急诊室心率的增加与肺部并发症有关。在逻辑回归中，氨甲环酸与肺部并发症发生率或存活率无关。根据逻辑回归或倾向评分匹配分析，各组间的存活率没有差异：结论：氨甲环酸对穿透性创伤患者的肺部并发症没有保护作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.