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Unkritischer Gebrauch von Tranexamsäure bei Traumapatienten

Do no further harm!

Uncritical use of tranexamic acid in trauma patients

Do no further harm!

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Zusammenfassung

Auf Grundlage der CRASH-2-Studie wird das Antifibrinolytikum Tranexamsäure (TXA) zum frühen Einsatz bei Traumapatienten mit Blutung oder Risiko für eine signifikante Blutung empfohlen und viele Traumazentren und prähospitale Rettungssysteme haben diese Praxis in ihre Behandlungsalgorithmen aufgenommen. Die Schwächen der CRASH-2-Studie sind bekannt und Nachfolgeuntersuchungen konnten die positiven Effekte dieser Studie mitunter nicht reproduzieren. Der genaue Wirkmechanismus von TXA im Traumakontext ist nach wie vor unklar und substanzielle Wissenslücken im Umgang mit TXA beim Trauma sind beschrieben. Komponentenanalysen belegen inzwischen unterschiedliche Phänotypen der akuten traumatischen Gerinnungsstörung und aktuelle Daten zeigen, dass möglicherweise der häufigste Phänotyp der Fibrinolyse nach schwerem Trauma bei Schockraumaufnahme nicht, wie ursprünglich angenommen, die Hyperfibrinolyse ist, sondern die als sogenanntes „Shutdown“ bezeichnete Hypofibrinolyse (64 %). Viskoelastische Testverfahren (z. B. ROTEM®) bieten aktuell die beste Möglichkeit, den in der Akutphase vorliegenden Phänotyp der Fibrinolysestörung zu erfassen, und könnten möglicherweise die selektive und gezieltere Gabe von TXA unterstützen.

Abstract

Based upon the results of CRASH-2, early administration of antifibrinolytic tranexamic acid (TXA) is recommended in bleeding trauma patients or trauma patients presumed to bleed. Many trauma centers and emergency medical services have adopted this practice into their routine algorithms. The pitfalls of CRASH-2 have been discussed in the literature, but the positive effects could sometimes not be reproduced in follow-up studies. The mechanism of action of TXA in trauma is still not clear and major knowledge gaps with TXA in the context of trauma have been identified. Component analyses have indicated different phenotypes of fibrinolytic disturbances after trauma upon emergency department admission with fibrinolytic “shutdown” potentially representing the most prominent and frequent phenotype (64 %). Viscoelastic tests, e. g. ROTEM®, are currently the best method to assess fibrinolytic phenotype in the acute phase and may support more selective TXA administration and therapies in trauma.

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  1. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, Klinikum Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland

    M. Maegele

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M. Maegele erhielt Honorare für Beratertätigkeiten von Astra Zeneca, TEM International, CSL Behring, Bayer und LFB France. Ihm wurden Teilnahmegebühren für Kongresse sowie Reise- und Übernachtungskosten erstattet. Er erhielt Honorare für Vorträge auf wissenschaftlichen Tagungen und Gelder für von ihm initiierte Forschungsvorhaben von LFB France und CSL Behring.

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Maegele, M. Unkritischer Gebrauch von Tranexamsäure bei Traumapatienten. Unfallchirurg 119, 967–972 (2016). https://doi.org/10.1007/s00113-016-0236-7

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