ArticleTransfusion2016
Fibrinolytic shutdown: fascinating theory but randomized controlled trial data are needed.
Article in Transfusion, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Effects of tranexamic acid treatment in severely and non-severely injured trauma patients.Transfusion · 2022Pooled it
- TEG Lysis Shutdown Represents Coagulopathy in Bleeding Trauma Patients: Analysis of the PROPPR Cohort.Shock (Augusta, Ga.) · 2019Trial
- Trial
- Local delivery of tranexamic acid for hemorrhage control in trauma: a narrative review.Frontiers in drug delivery · 2026Review
- State-by-state estimates of avoidable trauma mortality with early and liberal versus delayed or restricted administration of tranexamic acid.BMC emergency medicine · 2022Review
- Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study.TH open : companion journal to thrombosis and haemostasis · 2022Article
- Viscoelastic Hemostatic Assays for Postpartum Hemorrhage.Journal of clinical medicine · 2021Review
- Euglobulin clot lysis time reveals a high frequency of fibrinolytic activation in trauma.Thrombosis research · 2021Article
- Thromboembolic complications in critically ill COVID-19 patients are associated with impaired fibrinolysis.Critical care (London, England) · 2020Article
- Hemostatic agents for prehospital hemorrhage control: a narrative review.Military Medical Research · 2020Review
- Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications.Anesthesia and analgesia · 2019Review
- The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management.Korean journal of anesthesiology · 2019Review
- Does Tranexamic Acid Improve Clot Strength in Severely Injured Patients Who Have Elevated Fibrin Degradation Products and Low Fibrinolytic Activity, Measured by Thrombelastography?Journal of the American College of Surgeons · 2019Article
- Remote Damage Control Resuscitation in Austere Environments.Wilderness & environmental medicine · 2017Review
- Review
- New Advances in the Care of the Hemorrhaging Patient.Missouri medicineReview
Corrections and comments
- Commented on by
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Administration of tranexamic acid (TXA) to bleeding trauma patients who are within 3 hours of injury has been shown to safely reduce mortality in bleeding trauma patients. However, some believe that thromboelastography (TEG or ROTEM) can be used to subdivide these patients into those that will benefit from TXA and those that will be harmed by it. If thromboelastography can be used in this way there could be important patient benefits. However, if the approach is misguided, patients could be denied a lifesaving treatment. I believe that rather than debate the theoretical basis of this hypothesis, it should be tested by conducting a randomized controlled trial. Bleeding trauma patients who are within 3 hours of injury should be randomly allocated to receive TXA treatment or thromboelastometry-guided TXA treatment with the risk of death and complications compared between the groups. An adequately powered clinical trial would better serve patient interest than ongoing debate.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.