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Blutungsmanagement: Tranexamsäure in der Präklinik. Pro und Kontra

Coagulation management: prehospital tranexamic acid. Pro and contra

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Zusammenfassung

Das Antifibrinolytikum Tranexamsäure (TXA) ist in den letzten Jahren zunehmend in den Fokus der Gerinnungstherapie traumatisierter Patienten gekommen. Basierend auf den Ergebnissen der prospektiven, multizentrischen „Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage-2 (CRASH-2)“-Studie an 20.211 Traumapatienten kam es in Europa sehr rasch zu hochgradigen Empfehlungen für TXA. Die Übertragbarkeit der Ergebnisse auf moderne, hoch entwickelte Notarztsysteme wird jedoch zunehmend infrage gestellt und durch einige Studien bezweifelt. Auch lassen die fortschreitenden Kenntnisse der traumainduzierten Gerinnungsstörung mit unterschiedlichen Phänotypen eine universelle Anwendung von TXA bei jedem Trauma nicht sinnvoll erscheinen. TXA ist ein Medikament, als solches benötigt es eine Indikation, hat Wirkungen, aber auch Nebenwirkungen. Gerade bei schwerverletzen Patienten, der laut aktuellen Empfehlungen primären Zielgruppe, gibt es Hinweise auf eine reduzierte Sterblichkeit, aber zunehmend auch auf thromboembolische Effekte. Evidenzbasierte Aussagen zur prähospitalen Gabe von TXA werden erst durch die Auswertung aktuell laufender Studien möglich sein.

Abstract

The use of tranexamic acid (TXA), an antifibrinolytic drug, has received increasing attention in the coagulation management of severely injured patients. Based on the results of the prospective, multicenter Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage-2 (CRASH-2) study with 20,211 patients, European experts were fairly quick to give high grading recommendations for TXA. However, the transferability of these results to modern trauma systems remains questionable and is doubted by some studies. Growing knowledge of trauma-induced coagulopathy with different phenotypes also impedes the universal application of TXA for all trauma patients. TXA is a medication; therefore, it requires an indication and has effects but also side effects. Especially in severely injured patients, TXA’s current target population, some recent publications find a decreased mortality but increased thromboembolic effects. Only after evaluation of the results of current trials are evidence-based recommendations for prehospital application of TXA possible.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Köln, Deutschland

    H. Lier

  2. Sektion „Hämotherapie und Hämostasemanagement“, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI), Luisenstraße 45, 10117, Berlin, Deutschland

    H. Lier

  3. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, Klinikum Köln-Merheim, Universität Witten/Herdecke, Ostmerheimerstr. 200, 51109, Köln, Deutschland

    M. Maegele

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H. Lier erhielt Vortragshonorare und Reisekostenerstattungen von Bayer Vital, Blutspendedienst West (DRK), CSL Behring, Ferring, Mitsubishi Pharma, NovoNordisk und IL Werfen. M. Maegele erhielt Vortragshonorare und Reisekostenerstattungen, Honorare für Ad-Board Mitgliedschaften und Projektunterstützung von Astra Zeneca, Bayer, Biotest, CSL Behring, IL Werfen und LFB Biomedicaments.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Bernhard, Düsseldorf

H. Dormann, Fürth

C. Waydhas, Bochum

Dieser Beitrag beleuchtet die Pro- und Kontra-Aspekte zum Einsatz von Tranexamsäure beim Blutungsmanagement in der Präklinik. Die Kontra-Argumente sind im Beitragstext kursiv dargestellt.

H. Lier und M. Maegele teilen sich die Erstautorenschaft.

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Lier, H., Maegele, M. Blutungsmanagement: Tranexamsäure in der Präklinik. Pro und Kontra. Notfall Rettungsmed 22, 685–695 (2019). https://doi.org/10.1007/s10049-018-0471-2

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