Bolus-Only Versus Bolus-Plus-Infusion Tranexamic Acid for Trauma: A Propensity Score-Matched Study.

IF 2.2 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2026-10-04 DOI:10.1002/wjs.70587

Soon Ki Min, Kang Kook Choi, Byungchul Yu, Gil Jae Lee, Min A Lee, Seunghwan Lee, Sebeom Jeon, Myungjin Jang

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引用次数: 0

Abstract

Background: The CRASH-2 regimen for tranexamic acid (TXA) consists of a 1-g intravenous bolus followed by a 1-g infusion over 8 hours. The maintenance infusion may be challenging to administer during the early phase of trauma resuscitation. We compared mortality outcomes between patients receiving a 1-g TXA bolus alone and those receiving a bolus-plus-infusion regimen.

Methods: We conducted a retrospective cohort study of adult trauma patients (≥ 19 years) who presented directly to the trauma bay at a regional trauma center between July 2018 and December 2023. Patients who received TXA within 3 hours of injury were included in the inter-regimen analysis and categorized into either a 1-g bolus-only group or a 1-g bolus plus 1-g infusion group. Clinical outcomes were compared using multivariable logistic regression. To minimize selection bias and baseline imbalances, 1:1 propensity score matching was performed, followed by McNemar testing and conditional logistic regression analyses in the matched cohort.

Results: Among 5204 eligible patients, 1787 received TXA. The primary inter-regimen cohort included 1408 patients treated within 3 hours of injury: 409 received bolus-only TXA and 999 received bolus-plus-infusion TXA. Propensity score matching yielded 335 pairs. After matching, mortality did not differ significantly between the groups: in-hospital mortality 14.0% versus 17.3% (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 0.84-1.97; p = 0.240), 24-h mortality 4.5% versus 5.1% (aOR, 1.13; 95% CI, 0.57-2.27; p = 0.724), and 28-day mortality 9.3% versus 11.9% (aOR, 1.36; 95% CI, 0.81-2.28; p = 0.243).

Conclusions: In this single-center retrospective cohort study, a 1-g TXA bolus alone was associated with mortality outcomes comparable to those of the conventional bolus-plus-infusion regimen among patients treated within 3 hours of injury. Prospective studies are warranted to validate these findings.

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创伤单剂量注射与单剂量注射加输注氨甲环酸：一项倾向评分匹配研究。

背景：氨甲环酸（TXA）的CRASH-2方案包括1 g静脉注射，然后1 g输注，持续8小时。在创伤复苏的早期阶段，维持输注可能具有挑战性。我们比较了单独接受1克TXA丸和接受丸加输注方案的患者的死亡率结果。方法：我们对2018年7月至2023年12月期间直接到区域创伤中心创伤室就诊的成人创伤患者（≥19岁）进行了回顾性队列研究。在损伤后3小时内接受TXA治疗的患者被纳入方案间分析，并被分为仅服用1g丸组和服用1g丸加1g输注组。临床结果采用多变量logistic回归进行比较。为了尽量减少选择偏差和基线不平衡，进行了1:1的倾向评分匹配，然后在匹配的队列中进行McNemar检验和条件逻辑回归分析。结果：5204例符合条件的患者中，1787例接受了TXA治疗。主要的方案间队列包括1408名在损伤3小时内接受治疗的患者：409名患者仅接受丸剂TXA治疗，999名患者接受丸剂加输注TXA治疗。倾向得分匹配得到335对。匹配后，两组之间的死亡率没有显著差异：住院死亡率14.0%对17.3%（校正优势比[aOR]， 1.29； 95%置信区间[CI]， 0.84-1.97; p = 0.240）， 24小时死亡率4.5%对5.1% (aOR, 1.13; 95% CI, 0.57-2.27; p = 0.724)， 28天死亡率9.3%对11.9% （aOR, 1.36; 95% CI, 0.81-2.28; p = 0.243）。结论：在这项单中心回顾性队列研究中，在受伤后3小时内治疗的患者中，单独服用1g TXA丸与常规丸加输注方案的死亡率结果相当。有必要进行前瞻性研究来验证这些发现。

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

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.