ArticleJournal of the American College of Surgeons2019
Does Tranexamic Acid Improve Clot Strength in Severely Injured Patients Who Have Elevated Fibrin Degradation Products and Low Fibrinolytic Activity, Measured by Thrombelastography?
Article in Journal of the American College of Surgeons, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 55 citations in OpenAlex.
- [Evaluation of the Efficacy and Tolerance of Tranexamic Acid Combined with InoserpMedecine tropicale et sante internationale · 2026Trial
- Change in novel plasmin activated clotting time assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma in under 3 minutes.American journal of surgery · 2025Article
- A Novel Fibrinolysis Resistance Capacity Assay can Detect Fibrinolytic Phenotypes in Trauma Patients.Thrombosis and haemostasis · 2025Article
- Tranexamic acid in multiply injured patients-the independent risk of thromboembolic complications with repeated dosing: retrospective analysis based on the TraumaRegister DGU®.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Coagulopathy as a predictor of the effectiveness of tranexamic acid in severe blunt trauma: a multicenter retrospective study.Thrombosis journal · 2025Article
- Article
- Blood failure: traumatic hemorrhage and the interconnections between oxygen debt, endotheliopathy, and coagulopathy.Clinical and experimental emergency medicine · 2024Article
- Mechanisms and management of the coagulopathy of trauma and sepsis: trauma-induced coagulopathy, sepsis-induced coagulopathy, and disseminated intravascular coagulation.Journal of thrombosis and haemostasis : JTH · 2023Article
- Fibrinolysis Shutdown and Hypofibrinolysis Are Not Synonymous Terms: The Clinical Significance of Differentiating Low Fibrinolytic States.Seminars in thrombosis and hemostasis · 2023Review
- SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock.Frontiers in physiology · 2023Review
- Total Hip Arthroplasty Patients with Distinct Postoperative Fibrinolytic Phenotypes Require Different Antifibrinolytic Strategies.Journal of clinical medicine · 2022Article
- Not all patients benefit from the postoperative antifibrinolytic treatment: clinical evidence against the universal use of tranexamic acid following total knee arthroplasty.Journal of orthopaedic surgery and research · 2022Article
- Fibrinolytic system activation immediately following trauma was quickly and intensely suppressed in a rat model of severe blunt trauma.Scientific reports · 2021Article
- The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient.Hospital pharmacy · 2021Review
- Trauma-induced coagulopathy.Nature reviews. Disease primers · 2021Review
- Detection of early allograft dysfunction at 30 min of reperfusion in liver transplantation: An intraoperative diagnostic tool with real time assessment of graft function.American journal of surgery · 2020Article
- A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation.American journal of surgery · 2020Article
- Study of alteplase for respiratory failure in severe acute respiratory syndrome coronavirus 2/COVID-19: Study design of the phase IIa STARS trial.Research and practice in thrombosis and haemostasis · 2020Article
- Modern Management of Bleeding, Clotting, and Coagulopathy in Trauma Patients: What Is the Role of Viscoelastic Assays?Current trauma reports · 2020Article
- D-dimer levels at the time of admission to hospital as a predictor of outcome in trauma patients: A prospective observational study.Saudi journal of anaesthesiaArticle
Corrections and comments
- Commented on byDiscussion.2019
Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundElevated d-dimers in injured patients with paradoxically low fibrinolysis activity measured by viscoelastic assays have been speculated to be "occult" fibrinolysis. However, an alternative explanation is that these patients have previously activated their fibrinolytic system and have shut it down by the time of blood draw, and would gain no benefit in clot strength with tranexamic acid (TXA). We hypothesize that TXA will not increase clot strength in injured patients with low fibrinolytic activity measured by thrombelastography (TEG), despite biomarkers of fibrinolysis activation. STUDY
designThree TEG assays (rapid, tissue plasminogen activator, and functional fibrinogen) were run on trauma patients. The tissue plasminogen activator TEG served as a functional assay to quantify depletion of fibrinolysis inhibitors (DFI). Patients were stratified by DFI vs non-DFI and then by rapid TEG lysis at 30 minutes phenotype cutoffs. Response to TXA was evaluated with functional fibrinogen TEG by calculating percent change in clot strength with the addition of exogenous TXA in the TEG cup.
resultsSix hundred and thirty patients with a median new injury severity score of 20 were analyzed. Depletion of fibrinolysis inhibitors was present in 116 (18%). The DFI patients had significantly increased d-dimer (p < 0.001) and lower fibrinogen (p < 0.001). The DFI patients had increased rates of massive transfusion (33% vs 3.3%; p < 0.001) and mortality (40% vs 6.2%; p < 0.001). Among DFI patients, TXA significantly improved fibrin clot strength with hyperfibrinolysis (+19% clot strength; p < 0.001) but not with shutdown (+1.2%) or physiologic (-2.5%).
conclusionsPatients with DFI have multiple abnormalities of their coagulation system, but only DFI patients with hyperfibrinolysis have improved fibrin clot strength with TXA.
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