Efficacy of Tranexamic Acid in Blood Versus Crystalloid-Resuscitated Trauma/Hemorrhagic Shock.

Abstract

INTRODUCTION:

Whole blood (WB) or blood products are not always immediately available for repletion of lost intravascular volume in trauma/hemorrhagic shock (T/HS), and thus, resuscitation with crystalloid solutions is often necessary. Recently, we have shown enteral tranexamic acid (TXA) to be effective as a mild protease inhibitor in blood-resuscitated T/HS by counteracting proteolytic activity in and leaking from the gut with resultant preservation of systemic vascular integrity. We hypothesized that enteral TXA would improve hemodynamic stability after T/HS in the absence of blood reperfusion.

METHODS:

We directly compared resuscitation with enteral TXA versus intravenous (IV) TXA in conjunction with lactated Ringer's solution (LR) or WB reperfusion in an experimental T/HS model. Rats were subjected to laparotomy and exsanguinated to a mean arterial blood pressure of 35-40 mm Hg for 90 min, followed by LR or WB reperfusion and monitored for 120 min. TXA was administered via IV (10 mg/kg) or enteral infusion (150 mM) 20 min after establishment of hemorrhage for 150 min.

RESULTS:

Animals resuscitated with LR were unable to restore or maintain a survivable mean arterial blood pressure (>65 mm Hg), regardless of TXA treatment route. In contrast, rats reperfused with WB and given TXA either enterally or IV displayed hemodynamic improvements superior to WB controls.

CONCLUSIONS:

Results suggest that the beneficial hemodynamic responses to enteral or IV TXA after experimental T/HS depend upon reperfusion of WB or components present in WB as TXA, regardless of delivery mode, does not have appreciable hemodynamic effects when paired with LR reperfusion.

• Authors: Fernando Dos Santos, Joyce B Li, Rafi Mazor, Federico Aletti, Erik B Kistler
• Journal: The Journal of surgical research (J Surg Res) Vol. 279 Pg. 89-96 (11 2022) ISSN: 1095-8673 [Electronic] United States
• PMID: 35752157 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Published by Elsevier Inc.

Chemical References

• Crystalloid Solutions
• Isotonic Solutions
• Protease Inhibitors
• Ringer's Lactate
• Tranexamic Acid

Topics

• Animals
• Blood Pressure
• Crystalloid Solutions
• Isotonic Solutions (pharmacology, therapeutic use)
• Protease Inhibitors (pharmacology)
• Rats
• Resuscitation (methods)
• Ringer's Lactate
• Shock, Hemorrhagic (drug therapy)
• Tranexamic Acid (pharmacology, therapeutic use)