氨甲环酸在资源有限的创伤系统中与伤后死亡率相关:来自长期创伤护理队列研究的流行病学和结果。

IF 2.5 3区 医学 Q2 HEMATOLOGY
Transfusion Pub Date : 2025-05-01 Epub Date: 2025-02-28 DOI:10.1111/trf.18171
Adane F Wogu, Julia M Dixon, Mengli Xiao, Hendrick J Lategan, George Oosthuizen, Steven G Schauer, Elmin Steyn, Smitha Bhaumik, Janette Verster, Craig Wylie, Shaheem de Vries, Mohammad Mayet, Lesley Hodsdon, Leigh Wagner, L' Oreal Snyders, Karlien Doubell, Denise Lourens, Willem Stassen, Christiaan Rees, Jessica Young, Ernest E Moore, Nee-Kofi Mould-Millman
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引用次数: 0

摘要

背景:与伤害有关的死亡每年夺去数百万人的生命,其中严重出血是主要原因。本研究评估创伤患者损伤后3小时内给予氨甲环酸(TXA)对死亡率的影响。研究设计和方法:我们对南非创伤患者的多中心前瞻性队列EpiC进行了二级数据库分析。我们比较了有创伤性出血风险的严重损伤患者在伤后3小时内接受TXA治疗与未接受治疗的患者的死亡率。校正混杂因素的治疗加权逆概率和多变量逻辑回归评估24小时死亡率,并进行扩展的次要结局分析。结果:在3607例分析患者中,502例在3小时内接受了TXA治疗。TXA使24小时死亡率降低38%(边际优势比[more], 0.62;95%可信区间[CI], 0.49-0.78)。长期死亡率也出现了类似的下降。亚组分析显示,损伤后2小时内给予TXA可降低死亡率(more, 0.57;95% CI, 0.45-0.73),在3小时内给药1 g TXA (more or, 0.73;95% CI, 0.56-0.94),以及出血风险最高的患者(more, 0.40;95% ci, 0.30-0.53)。穿透伤患者24小时死亡率显著降低(more or, 0.58;95% CI, 0.43-0.78),但不适用于钝性损伤患者。敏感性分析证实了这些发现的稳健性,在各个亚组中,TXA持续降低了28%-39%的死亡率。讨论:早期给药可显著降低创伤患者的死亡率,尤其是穿透性损伤和出血风险最高的患者。1克剂量与高剂量同样有效,损伤后2小时内给予TXA可显著降低死亡率。这些发现支持在资源有限的创伤治疗方案中使用TXA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tranexamic acid is associated with post-injury mortality in a resource-limited trauma system: Findings from the epidemiology and outcomes of prolonged trauma care cohort study.

Background: Injury-related deaths claim millions of lives annually, with severe hemorrhage a leading cause. This study assesses tranexamic acid (TXA) administered within 3 h post-injury on mortality in trauma patients.

Study design and methods: We conducted secondary database analysis of EpiC, a multicenter, prospective cohort of trauma patients in South Africa. We compared mortality between severely injured patients at risk for traumatic hemorrhage receiving TXA within 3 h post-injury versus untreated patients. Inverse probability of treatment weighting adjusted for confounders, and multivariate logistic regression assessed 24-h mortality, with extended secondary outcome analyses.

Results: Of 3607 analyzed patients, 502 received TXA within 3 h. TXA reduced 24-h mortality by 38% (marginal odds ratio [mOR], 0.62; 95% confidence interval [CI], 0.49-0.78) versus untreated patients. Similar reductions were observed for longer-term mortality. Subgroup analyses revealed reduced mortality when TXA was given within 2 h post-injury (mOR, 0.57; 95% CI, 0.45-0.73), doses of 1 g of TXA within 3 h (mOR, 0.73; 95% CI, 0.56-0.94), and those with the highest risk of hemorrhage (mOR, 0.40; 95% CI, 0.30-0.53). The 24-h mortality reduction was significant for patients with penetrating injury (mOR, 0.58; 95% CI, 0.43-0.78) but not for blunt injury patients. Sensitivity analyses confirmed the robustness of these findings, with TXA consistently reducing mortality odds by 28%-39% across subgroups.

Discussion: Early TXA administration significantly reduced mortality in trauma patients, especially with penetrating injuries and those with the highest risk of hemorrhage. One-gram dosing was as effective as higher doses, and mortality reduction was notable when TXA was given within 2 h post-injury. These findings support TXA use in resource-limited trauma protocols.

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来源期刊
Transfusion
Transfusion 医学-血液学
CiteScore
4.70
自引率
20.70%
发文量
426
审稿时长
1 months
期刊介绍: TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.
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