title: The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.
abstract: BACKGROUND
  Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system.
  
  
  METHODS
  From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM.
  
  
  RESULTS
  The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration.
  
  
  CONCLUSIONS
  HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease.
  
  
  CONCLUSIONS
  The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption.
  
  
  BACKGROUND
  ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. nkunze@gwdg.de.
authors.forename: Nils
authors.initials: N
authors.lastname: Kunze-Szikszay
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Lennart A
authors.initials: LA
authors.lastname: Krack
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Pauline
authors.initials: P
authors.lastname: Wildenauer
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Wand
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Heyne
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Karoline
authors.initials: K
authors.lastname: Walliser
authors.affiliation: Department for Trauma Surgery and Orthopaedics, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Spering
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
authors.affiliation: Department for Anaesthesiology, University Medical Centre, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Roessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001777:Blood Coagulation / Q000502:physiology*; D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*; D014148:Tranexamic Acid / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Coagulopathy; Fibrinolysis; Pre-hospital care; Thrombelastometry; Tranexamic acid; Trauma