Background: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This\nstudy investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii)\nthe effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system.\nMethods: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ââ?°Â¥16 points blood was\nobtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after\nthe first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples,\nand the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM.\nResults: The median (min-max) ISS was 17 points (4ââ?¬â??50 points). Four patients (15 %) had HF diagnosed via ROTEM\nat the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before\nTxA administration was 11 % (3ââ?¬â??99 %) vs. 10 % after TxA administration (4ââ?¬â??18 %; p > 0.05). TxA was administered\n37 min (10ââ?¬â??85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly\ndiffer. No adverse drug reactions were observed after TxA administration.\nDiscussion: HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy\nadministered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically\nlow levels. Early administration of TxA cannot reverse or entirely stop this decrease.\nConclusions: The pre-hospital use of TxA should be considered for severely injured patients to prevent the\nworsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption.
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