J.M. Townsend2, D. Lammers2, J.B. Holcomb2, J.R. Richter2 2University Of Alabama at Birmingham, Trauma And Acute Care Surgery, Birmingham, Alabama, USA
Introduction:
Tranexamic acid (TXA) is a lysine analog that has been shown to decrease mortality in trauma patients by preventing fibrinolysis and promoting hemostasis. In addition to its effects on blood clot stability, in vitro and clinical studies suggest that TXA may also mitigate vascular endothelial damage as evidenced by decreased levels of syndecan-1 (Sdc-1), a marker for endothelial glycocalyx injury. Despite this, the relationship between TXA and Sdc-1 following varied mechanisms of traumatic injury remains unclear. This study sought to compare the effect of TXA on Sdc-1 shedding in blunt versus penetrating injury.
Methods:
A retrospective analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial was conducted. Patients were stratified by mechanism of injury. Within each mechanism group, case-control matching was used to select for patients with similar injury severity based on Injury Severity Score (ISS). Plasma Sdc-1 levels measured at 0, 2, 4, 6, 12, 24, 48 and 72 hours after hospital arrival were compared between patients that received TXA and those that did not in both the blunt and penetrating trauma groups. Matched groups were analyzed using a two-way ANOVA.
Results:
Following case-control matching, 168 patients with a blunt mechanism of injury (84 TXA vs 84 non-TXA) and 104 patients with a penetrating mechanism of injury (52 TXA vs 52 non-TXA) were analyzed. TXA administration demonstrated no statistically significant differences in Scd-1 levels when compared to the non-TXA cohorts in both blunt (Fig 1A) or penetrating (Fig 1B) mechanism of injuries at any time point.
Conclusion:
TXA administration was not associated with decreased Scd-1 levels in patients sustaining blunt or penetrating injuries. Future efforts should seek to assess for differences in trauma-centric pathologies based on blunt versus penetrating injury due to their differing physiologic host-responses.