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Use of Tranexamic Acid With Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated With Higher Distal Embolism Rates: Results From the American Association of Surgery for Trauma Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery Trial.
Shaw, Joanna; Zakhary, Bishoy; Coimbra, Raul; Moore, Laura; Scalea, Thomas; Kundi, Rishi; Teeter, William; Romagnoli, Anna; Moore, Ernest; Sauaia, Angela; Dennis, Bradley; Brenner, Megan.
Afiliación
  • Shaw J; UCLA, Los Angeles, CA, USA.
  • Zakhary B; Riverside University Health System, Department of Surgery, 26520 Cactus Ave, Moreno Valley, CA 92555.
  • Coimbra R; Riverside University Health System, Department of Surgery, 26520 Cactus Ave, Moreno Valley, CA 92555.
  • Moore L; University of Texas Health Science Center at Houston (UTHealth), Department of Surgery, 6431 Fannin Street, Houston TX 77030.
  • Scalea T; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201.
  • Kundi R; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201.
  • Teeter W; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201.
  • Romagnoli A; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201.
  • Moore E; University of Colorado Anschutz Medical Campus, Department of Surgery, 12631 East 17th Avenue, Aurora, CO 80045.
  • Sauaia A; University of Colorado Anschutz Medical Campus, Department of Surgery, 12631 East 17th Avenue, Aurora, CO 80045.
  • Dennis B; Vanderbilt University Medical Center, Division of Acute Care Surgery, 1161 21st,Avenue South, Medical Center North, D-5203, Nashville, TN 37232.
  • Brenner M; UCLA, Los Angeles, CA, USA.
Am Surg ; 89(10): 4208-4217, 2023 Oct.
Article en En | MEDLINE | ID: mdl-37431165
INTRODUCTION: Tranexamic acid (TXA) use has been associated with thrombotic complications. OBJECTIVE: We aim to investigate outcomes associated with TXA use in the setting of high- (HP) and low-profile (LP) introducer sheaths for resuscitative endovascular balloon occlusion of the aorta (REBOA). PARTICIPANTS: The Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery (AORTA) database was queried for patients who underwent REBOA using a low-profile 7 French (LP) or high-profile, 11-14 French (HP) introducer sheaths between 2013 and 2022. Demographics, physiology, and outcomes were examined for patients who survived beyond the index operation. RESULTS: 574 patients underwent REBOA (503 LP, 71 HP); 77% were male, mean age was 44 ± 19 and mean injury severity score (ISS) was 35 ± 16. 212 patients received TXA (181 [36%] LP, 31 [43.7%] HP). There were no significant differences in admission vital signs, GCS, age, ISS, SBP at AO, CPR at AO, and duration of AO among LP and HP patients. Overall, mortality was significantly higher in the HP (67.6%) vs the LP group (54.9%; P = .043). Distal embolism was significantly higher in the HP group (20.4%) vs the LP group (3.9%; P < .001). Logistic regression demonstrated that TXA use was associated with a higher rate of distal embolism in both groups (OR = 2.92; P = .021). 2 LP patients (one who received TXA) required an amputation. CONCLUSION: Patients who undergo REBOA are profoundly injured and physiologically devastated. Tranexamic acid was associated with a higher rate of distal embolism in those who received REBOA, regardless of access sheath size. For patients receiving TXA, REBOA placement should be accompanied by strict protocols for immediate diagnosis and treatment of thrombotic complications.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Hemorrágico / Ácido Tranexámico / Oclusión con Balón / Embolia / Procedimientos Endovasculares Tipo de estudio: Guideline / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Am Surg Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Hemorrágico / Ácido Tranexámico / Oclusión con Balón / Embolia / Procedimientos Endovasculares Tipo de estudio: Guideline / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Am Surg Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos