scholarly journals Intramuscular uptake of tranexamic acid during haemorrhagic shock in a swine model

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Håkon Kvåle Bakke ◽  
Ole Martin Fuskevåg ◽  
Erik Waage Nielsen ◽  
Erik Sveberg Dietrichs
Keyword(s):  
Tranexamic Acid ◽  
Blood Perfusion ◽  
Haemorrhagic Shock ◽  
Control Group ◽  
Swine Model ◽  
Trauma Patients ◽  
Serum Concentrations ◽  
Maximum Serum ◽  
Liquid Chromatography Tandem Mass ◽  
The Impact

Abstract Background Tranexamic acid (TXA) reduce mortality in bleeding trauma patients, with greater effect if administered early. Serum concentrations above 10 µg/mL are considered sufficient to inhibit fibrinolysis. Normally administered intravenously (i.v.), TXA can also be administered intramuscularly (i.m.). This could be advantageous in low resource and military settings, if sufficient serum concentrations can be reached in shocked patients with reduced muscular blood perfusion. Accordingly, we aimed to: (1) Determine the impact of shock on the pharmacokinetics of i.m. TXA, and (2) Compare the pharmacokinetics of i.v. versus i.m. TXA in ongoing shock. Materials and methods In a prospective experimental study, N = 18 Norwegian landrace pigs (40–50 kg), utilised in a surgical course in haemostatic emergency surgery, were subjected to various abdominal and thoracic trauma. After 1 h of surgery the animals were given 15 mg/kg TXA either i.v. or i.m. A control group without injury, or surgery, received intramuscular TXA. Blood samples were drawn at 0, 5, 15, 25, 35, 45, 60 and 85 min. The samples were centrifuged and analysed with liquid chromatography–tandem mass spectrometry (LC–MS/MS) for TXA serum-concentrations. Results In shocked pigs, i.m. administration resulted in a mean maximum serum concentration (Cmax) of 20.9 µg/mL, and i.v. administration a Cmax of 48.1 µg/mL. Cmax occurred 15 min after i.m. administration and 5 min after i.v. administration. In non-shocked swine, i.m. administration resulted in a Cmax of 36.9 µg/mL after 15 min. In all groups, mean TXA serum concentrations stayed above 10 µg/mL from administration to end of experiments. Conclusions I.m. administration of TXA in shocked pigs provides serum concentrations associated with inhibition of fibrinolysis. It may be an alternative to i.v. and intraosseous administration during stabilisation and transport of trauma patients to advanced medical care.

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

Multimodal Analgesia and Decreased Opioid Use in Adult Trauma Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 950-954
Author(s):  
Andrew L. Drahos ◽  
Anthony M. Scott ◽  
Tracy J. Johns ◽  
Dennis W. Ashley
Keyword(s):  
Acute Kidney Injury ◽  
Management Strategies ◽  
Kidney Injury ◽  
Multimodal Analgesia ◽  
The United States ◽  
Control Group ◽  
Trauma Patients ◽  
Opioid Use ◽  
Trauma Service ◽  
The Impact

Background There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. Methods In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. Results A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease ( P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). Discussion Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.

scholarly journals Increased Growth Differentiation Factor 15 in Patients with Hypoleptinemia-Associated Lipodystrophy

2020 ◽  
Vol 21 (19) ◽  
pp. 7214 ◽  
Author(s):  
Susan Kralisch ◽  
Annett Hoffmann ◽  
Juliane Estrada-Kunz ◽  
Michael Stumvoll ◽  
Mathias Fasshauer ◽  
...  
Keyword(s):  
Mrna Expression ◽  
Transforming Growth Factor ◽  
Linear Regression Analysis ◽  
Control Group ◽  
Serum Concentrations ◽  
Metabolic Complications ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
Obesity And Diabetes ◽  
The Impact

Objective. Similar to obesity, lipodystrophy (LD) causes adipose tissue dysfunction and severe metabolic complications. Growth differentiation factor 15 (GDF15) belongs to the transforming growth factor β superfamily and is dysregulated in metabolic disease including obesity and diabetes mellitus. Circulating levels in LD and the impact of leptin treatment have not been investigated so far. Material and Methods. GDF15 serum levels were quantified in 60 LD patients without human immunodeficiency virus infection and 60 controls matched for age, gender, and body mass index. The impact of metreleptin treatment on circulating GDF15 was assessed in a subgroup of patients. GDF15 mRNA expression was determined in metabolic tissues of leptin-deficient lipodystrophic aP2-nSREBP1c-Tg mice, obese ob/ob mice, and control C57Bl6 mice. Results. Median GDF15 serum concentrations were significantly higher in LD patients (819 ng/L) as compared to the control group (415 ng/L) (p < 0.001). In multiple linear regression analysis, an independent and positive association remained between GDF15 on one hand and age, patient group, hemoglobin A1c, triglycerides, and C-reactive protein on the other hand. Moreover, there was an independent negative association between GFD15 and estimated glomerular filtration rate. Circulating GDF15 was not significantly affected by metreleptin treatment in LD patients. Gdf15 was upregulated in leptin-deficient lipodystrophic mice as compared to controls. Moreover, Gdf15 mRNA expression was downregulated by leptin treatment in lipodystrophic and obese animals. Conclusions. Serum concentrations of GDF15 are elevated in LD patients and independently associated with markers of metabolic dysfunction. Gdf15 expression is higher in lipodystrophic mice and downregulated by leptin treatment.

scholarly journals 45. The Impact of an Alert Tone on On-Scene Time in Trauma Patients

1996 ◽  
Vol 11 (S2) ◽  
pp. S42-S42
Author(s):  
Todd J. Le Duc ◽  
William E. Goellner ◽  
Nabil E. Sanadi
Keyword(s):  
Penetrating Trauma ◽  
Test Group ◽  
Control Group ◽  
Trauma Patients ◽  
Alert Message ◽  
The Impact ◽  
Versus Test

Objective: Determine whether radio alerts to paramedics after 7 minutes of on-scene time reduces total on-scene time for trauma patients.Methods: Paramedics radio base once they determine ACS criteria were met. Paramedics were informed by radio when 7 minutes lapsed on-scene. Dispatch times were recorded.Results: The control group (Nov. 1-30, 1995) of 135 consecutive patients were reviewed without a radio alert. The test group (Dec. 1-31, 1995) of 103 consecutive patients, with a radio alert message 7 minutes after scene arrival were also reviewed. Groups were matched for extrication times, blunt versus penetrating trauma, age, etc. We analyzed both groups for the interval of time from announcement of “trauma alert,” (when paramedics determined the patient met ACS criteria or from the time extrication was complete (if applicable) to the time en route to the hospital. Average on-scene time for the control group was 13.7 minutes [range 4-35] versus test group 9.3 minutes [range 2-26] (p <0.001).

scholarly journals Conditionally Essential Amino Acid Supplementation Reduces Postoperative Muscle Wasting in Orthopedic Trauma Patients

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1135-1135
Author(s):  
Aspen Miller ◽  
Nathan Hendrickson ◽  
John Davison ◽  
Erin Wilson ◽  
Natalie Glass ◽  
...  
Keyword(s):  
Amino Acids ◽  
Muscle Wasting ◽  
Fat Free Mass ◽  
Nutrition Status ◽  
Control Group ◽  
Trauma Patients ◽  
Complication Rates ◽  
Metabolic Demand ◽  
Post Surgery ◽  
The Impact

Abstract Objectives Increased metabolic demand and inadequate oral intake after musculoskeletal trauma results in catabolic skeletal muscle wasting, which limits potential for functional recovery after injury. This study compared standard perioperative nutrition and oral supplementation with conditionally essential amino acids (CEAA) on changes in lean body mass after operative fixation of acute fractures. Methods Patients sustaining operative pelvis and extremity fractures presenting to a Level 1 trauma center were prospectively enrolled in a single blinded-randomized clinical trial. Demographics, injury classification, and comorbidities were collected at baseline. Fat Free Mass (FFM) was measured within 72 hours of surgery using A-Mode Ultrasound. Patients were randomly chosen to receive standard nutrition (Control) or standard nutrition plus an oral supplement (CEAA) containing 14 g of amino acids to be taken 2x daily for 2 weeks. FFM was re-assessed at 6 weeks and 3 months post-surgery. Statistical analysis was performed comparing Least Squared Mean FFM (P &lt; .05). Results 222 subjects (Control: 112, CEAA: 120) were included in this analysis. There were no differences in age, gender, BMI, or baseline FFM between Control and CEAA subjects (all P &gt; .05). Median supplement compliance was 22/28 servings (78.6%, sd ± 36.9%). At 6 weeks, average change in FFM among Controls was −1.28 kg (P = .004) and -.56 kg among CEAA (P = .19). Changes were not significant between groups (P = .23). At 12 weeks, there were non-significant changes in FFM from baseline in both groups (Controls: -.02 kg P = .96, CEAA: +.36 kg P = .44). From 6–12 weeks, FFM changes were + 1.26 kg (P = .012) and + .91 kg (P = .06) respectively. Conclusions Patients randomized to standard nutrition had significant FFM loss compared to those receiving additional CEAA supplementation 6 weeks after surgery. At 12 weeks, the control group decreased FFM further from baseline while the CEAA group mostly recovered their loss. Although 12-week FFM changes were not significant, results indicate CEAA supplementation prevents FFM loss in the acute post-operative phase. Further investigation is needed to compare FFM changes, clinical outcomes, complication rates, and the impact of baseline nutrition status. Funding Sources American Academy of Orthopaedic Surgeons, Board of Specialty Societies Quality and Patient Safety Action Fund.

Determination of three unsaturated fatty acids in pressure ulcer rats using an UPLC-MS/MS method

2020 ◽  
Vol 16 ◽  
Author(s):  
Fuman Cai ◽  
Yuwei Dong ◽  
Shaosheng Lou ◽  
Zeping Ma ◽  
Ting Wu ◽  
...  
Keyword(s):  
Ammonium Acetate ◽  
Unsaturated Fatty Acids ◽  
Serum Levels ◽  
Ultra Performance Liquid Chromatography ◽  
Release Time ◽  
Control Group ◽  
Serum Concentrations ◽  
Chromatography Tandem Mass Spectrometry ◽  
Liquid Chromatography Tandem Mass

Background: The serum levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and arachidonic acid (AA) under the state of pressure ulcers (PUs) are still unclear. Introduction: In order to investigate serum levels of DHA, EPA, and AA in PUs rats, an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/ MS) method was developed and validated. Methods: Chromatographic separation of DHA, EPA, AA was carried out on a BEH C18 column and gradient elute consisted of 5 mM ammonium acetate-0.1% formic acid and acetonitrile. Subsequently, fifty rats were divided into five groups (n=10), four PU groups (A-D) underwent various pressure and release time protocols, with group E as the control. The concentrations of DHA, EPA, AA from five groups were determination using validated method. Results: The results showed there was good linearity for DHA (327.3/283.4), EPA (301.2/257.0), and AA (303.1/258.9) within 0.05-6.4 μg/mL. In control group, the levels of DHA, AA and EPA were 1.16±0.68, 0.59±0.19 and 0.78±0.21 μg/mL. At the end of modeling, concentrations of DHA, EPA and AA were increased after long and persistent pressure (>8 h). Especially, the level of DHA was significantly higher (P<0.01) than that of control group. Conclusion: A stable, reliable and accurate UPLC-MS/MS for determination of DHA, EPA, AA in blood was developed. Serum concentrations of DHA, EPA and AA were altered differently after long and persistent pressure (>8 h), and DHA is a remarkable one.

scholarly journals Pregnancy outcomes in women with severe hypothyroidism

2013 ◽  
Vol 169 (3) ◽  
pp. 313-320 ◽  
Author(s):  
Dania Hirsch ◽  
Sigal Levy ◽  
Varda Nadler ◽  
Vered Kopel ◽  
Bracha Shainberg ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Control Group ◽  
Study Group ◽  
Maximum Serum ◽  
Health Maintenance ◽  
Median Serum ◽  
The Impact ◽  
Serum Tsh ◽  
Tsh Levels

ObjectiveHypothyroidism during pregnancy has been associated with adverse obstetrical outcomes. Most studies have focused on subjects with a mild or subclinical disorder. The aims of the present study were to determine the relative rate of severe thyroid dysfunction among pregnant women with hypothyroidism, identify related factors and analyse the impact on pregnancy outcomes.DesignA retrospective case series design was employed.MethodsThe study group included 101 pregnant women (103 pregnancies) with an antenatal serum TSH level >20.0 mIU/l identified from the 2009–2010 computerised database of a health maintenance organisation. Data were collected from the medical records. Pregnancy outcomes were compared with those of a control group of 205 euthyroid pregnant women during the same period.ResultsThe study group accounted for 1.04% of all insured pregnant women with recorded hypothyroidism during the study period. Most cases had an autoimmune aetiology. All women were treated with levothyroxine (l-T4) during pregnancy. Maximum serum TSH level measured was 20.11–150 mIU/l (median 32.95 mIU/l) and median serum TSH level 0.36–75.17 mIU/l (median 7.44 mIU/l). The mean duration of hypothyroidism during pregnancy was 21.2±13.2 weeks (median 18.5 weeks); in 36 cases (34.9%), all TSH levels during pregnancy were elevated. Adverse pregnancy outcomes included abortions in 7.8% of the cases, premature deliveries in 2.9% and other complications in 14.6%, with no statistically significant differences from the control group. Median serum TSH level during pregnancy was positively correlated with the rate of abortions+premature deliveries and rate of all pregnancy-related complications (P<0.05).ConclusionsAbortions and premature deliveries occur infrequently in women with severe hypothyroidism. Intense follow-up and l-T4 treatment may improve pregnancy outcomes even when target TSH levels are not reached.

scholarly journals The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sebastian Imach ◽  
Arasch Wafaisade ◽  
Rolf Lefering ◽  
Andreas Böhmer ◽  
Mark Schieren ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Control Group ◽  
Transfusion Rate ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Match Pair ◽  
Transfusion Requirements ◽  
Injured Patients ◽  
The Impact

Abstract Background Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany. Methods The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included. Results The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080). Conclusion This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.

scholarly journals The Association between Maternal Stress and Glucocorticoid Rhythmicity in Human Milk

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1608
Author(s):  
Michelle Romijn ◽  
Luca J. L. van Tilburg ◽  
Jonneke J. Hollanders ◽  
Bibian van der Voorn ◽  
Paul de Goede ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Breast Milk ◽  
Human Milk ◽  
Area Under The Curve ◽  
Control Group ◽  
Increased Risk ◽  
Liquid Chromatography Tandem Mass ◽  
Highly Correlated ◽  
The Impact ◽  
Diurnal Rhythmicity

Background: Chronic stress is often accompanied by alterations in the diurnal rhythm of hypothalamus–pituitary–adrenal activity. However, there are limited data on the diurnal rhythmicity of breast milk glucocorticoids (GCs) among women with psychological distress. We compared mothers who sought consultation at an expertise center for pregnant women with an increased risk of psychological distress with control mothers for GC diurnal rhythmicity in milk and saliva obtained at the same time. Methods: We included 19 mothers who sought consultation at the psychiatry–obstetric–pediatric (POP) outpatient clinic and 44 control mothers. One month postpartum, mothers collected on average eight paired milk and saliva samples during a 24 h period. GC levels were measured using liquid chromatography–tandem mass spectrometry. GC rhythmicity parameters were determined with specialized software. Results: For both milk and saliva, no group differences regarding GC rhythms were found. Milk cortisol area under the curve with respect to the ground was lower in the POP group than in the control group (p = 0.02). GC levels in human milk and saliva were highly correlated within each group (p < 0.001). Conclusion: Although there were no differences between groups in GC rhythmicity, the total amount of milk cortisol was lower in the POP group. Long-term follow-up is needed to address the impact of vertical transmission of breast milk GCs.

scholarly journals Effects of Tranexamic Acid on Mortality and Blood Transfusion in Trauma Patients with Significant Hemorrhage: A Clinical Trial

2017 ◽  
Vol 5 (4) ◽  
pp. 24
Author(s):  
Farzad Kakaei ◽  
Peyman Virani ◽  
Shahriar Hashemzadeh ◽  
Sina Zarrintan ◽  
Samad Beheshtirouy ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Study Groups ◽  
Control Group ◽  
Case Group ◽  
Trauma Patients ◽  
Transfusion Rate ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Extensive hemorrhage is a significant cause of mortality in trauma patients. Tranexamic acid has been used for controlling bleeding in cardiovascular surgeries and dental manipulations in patients with hemophilia. However, in traumatic patients with bleeding, its use dates back to more recent years. This study aims to examine the effects of this drug on reducing mortality and blood transfusion rate in trauma patients with significant hemorrhage. A total of 60 patients with significant trauma-related hemorrhage (systolic blood pressure < 90 mmHg/heart rate > 110/min) from the emergency department of Imam Reza Hospital (Tabriz, Iran), were randomized in two groups. The case group received intravenous Tranexamic acid (1 g in 10 min and then 1 g over 8 h). The control group received placebo. Rate of transfusion and rate of one-month mortality were compared between the study groups. The mean ICU stay and overall hospitalization times did not have significant difference between two groups (p<0.05). Transfusion of packed cells was 6.03±1.50 and 6.03±1.22 units in case and control groups respectively. Transfusion of fresh frozen plasma (FFP) was 2.50±1.36 and 3.03±0.96 units in case and control groups respectively (p=0.09). Transfusion of platelets was 0.40±0.20 1.33±0.31 units in case and control groups respectively (p=0.01). Three patients (10%) in the case group and 4 patients (13.3%) in the control group were expired (p=0.50). Tranexamic acid is safe and effective in reducing platelet transfusion rate in patients with trauma-related significant hemorrhage. However, transfusion need and mortality would not reduce by its use in trauma patients. 

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