{"id":7233,"date":"2018-05-19T04:42:41","date_gmt":"2018-05-19T02:42:41","guid":{"rendered":"http:\/\/news-papers.eu\/?p=7233"},"modified":"2018-03-31T12:55:43","modified_gmt":"2018-03-31T10:55:43","slug":"txa-nicht-mit-der-giesskanne-teil-2","status":"publish","type":"post","link":"http:\/\/news-papers.eu\/?p=7233","title":{"rendered":"TXA \u2013 nicht mit der Gie\u00dfkanne! Teil 2"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"7238\" data-permalink=\"http:\/\/news-papers.eu\/?attachment_id=7238\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/05\/Bildschirmfoto-2018-03-31-um-12.50.32-e1522493478145.png?fit=300%2C197\" data-orig-size=\"300,197\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Bildschirmfoto 2018-03-31 um 12.50.32\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/05\/Bildschirmfoto-2018-03-31-um-12.50.32-e1522493478145.png?fit=1024%2C672\" class=\"size-medium wp-image-7238 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/05\/Bildschirmfoto-2018-03-31-um-12.50.32.png?resize=300%2C197\" alt=\"\" width=\"300\" height=\"197\" \/>Nun\u00a0Teil 2 des gemeinsamen Beitrages von Dr. Heiko Lier, K\u00f6ln\/Deutschland und PD Dr. J\u00fcrgen Knapp, Bern Schweiz:<\/strong><\/p>\n<p style=\"text-align: justify;\">Wie aus den Daten der oben zitierten Arbeit von Moore et al. hervorgeht, ist ein \u201eShutdown\u201c der Fibrinolyse mit einer erh\u00f6hten Mortalit\u00e4t im Vergleich zur physiologischen Fibrinolyse assoziiert. Dies wurde k\u00fcrzlich nochmals durch die gleiche Arbeitsgruppe best\u00e4tigt:<\/p>\n<blockquote><p><strong>Moore HB et al. Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients. J Am Coll Surg 2016; 222:347-55<\/strong><\/p><\/blockquote>\n<p style=\"text-align: justify;\">\u201eInjured\u00a0patients\u00a0included in the analysis were admitted between 2010 and 2013, were 18 years of age or older, and had an\u00a0Injury\u00a0Severity Score (ISS) &gt; 15. \u2026 There were 2,540\u00a0patients\u00a0who met inclusion criteria. Median age was 39 years (interquartile range [IQR] 26 to 55 years) and median ISS was 25 (IQR 20 to 33), with a\u00a0mortality\u00a0rate of 21%. Fibrinolysis\u00a0shutdown\u00a0was the most common phenotype (46%) followed by physiologic (36%) and hyperfibrinolysis (18%). Hyperfibrinolysis was associated with the highest death rate (34%), followed by\u00a0shutdown(22%), and physiologic (14%, p &lt; 0.001). The risk of\u00a0mortality\u00a0remained increased for hyperfibrinolysis (odds ratio [OR] 3.3, 95% CI\u00a02.4 to 4.6, p &lt; 0.0001) and\u00a0shutdown\u00a0(OR 1.6, 95% CI 1.3 to\u00a02.1, p\u00a0= 0.0003) compared with physiologic when adjusting for age, ISS, mechanism, head\u00a0injury, and blood pressure (area under the receiver operating characteristics curve 0.82, 95% CI 0.80 to 0.84).<\/p>\n<hr \/>\n<p style=\"text-align: justify;\">Aktuell ist nun erneut im J Trauma Acute Care Surg eine Arbeit ver\u00f6ffentlicht worden, die zeigt, dass durch die Gabe von TXA beim Traumapatienten ein \u201eShutdown\u201c der physiologischen Fibrinolyse induziert wird.<\/p>\n<blockquote>\n<p style=\"text-align: justify;\"><strong>Meizoso JP et al. Increased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid. <\/strong><strong>J Trauma Acute Care Surg 2018; 84:427-32<\/strong><\/p>\n<\/blockquote>\n<ul>\n<li>prospektive Beobachtungsstudie<\/li>\n<li>Level I-Trauma-Center in den USA<\/li>\n<li style=\"text-align: justify;\">218 schwerverletzte Patienten mit einem durchschnittlichen ISS von 28\u00b113<\/li>\n<li style=\"text-align: justify;\">183 Patienten (84%) haben keine TXA erhalten, 35 (16%) wurde TXA appliziert<\/li>\n<li style=\"text-align: justify;\">79 Patienten (36%) hatten zum Zeitpunkt der Aufnahme auf die Intensivstation keinen \u201cShutdown\u201c, 139 Patienten (64%) wiesen eine \u201eFibrinolysis shutdown\u201c auf<\/li>\n<li style=\"text-align: justify;\">bei Patienten, die einen \u201eShutdown\u201c der Fibrinolyse aufwiesen, hatten hochsignifikant h\u00e4ufiger TXA erhalten, als Patienten, die keinen \u201eShutdown\u201c aufwiesen<\/li>\n<li style=\"text-align: justify;\">durch eine Regressionsanalyse konnte die Gabe von TXA als wichtigster Risikofaktor f\u00fcr einen \u201eShutdown\u201c der Fibrinolyse identifiziert werden: relatives Risiko 1,35 (95%-Konfidenzintervall: 1,10-1,64, p=0,004)<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Hierzu passen auch die Ergebnisse der im vergangenen Monat im JAMA Surg ver\u00f6ffentlichten retrospektiven Beobachtungsstudie aus einem US-Milit\u00e4rhospital in Afghanistan. Hier konnte die Gabe von TXA als unabh\u00e4ngiger Risikofaktor f\u00fcr Thromboembolien identifiziert werden.<\/p>\n<blockquote><p><strong>Johnston LR et al. Evaluation\u00a0of\u00a0Military\u00a0Use of\u00a0Tranexamic\u00a0Acid\u00a0and Associated Thromboembolic Events. JAMA Surg 2018; 153:169-75.<\/strong><strong> 34,5% Thromboembolie-Rate in der TXA-Gruppe (n=139) vs. 6,8% ohne TXA (n=316, p&lt;0,001)\u00a0\u201eTranexamic\u00a0acid\u00a0administration was an independent risk factor for venous thromboembolism (odds ratio, 2.58; 95% CI, 1.20-5.56; P\u2009=\u2009.02).\u201c<\/strong><\/p><\/blockquote>\n<p style=\"text-align: justify;\">\u00c4hnliche Ergebnisse zeigte im vergangenen Jahr eine retrospektive Beobachtungsstudie ebenfalls aus dem US-Milit\u00e4r:<\/p>\n<ul>\n<li style=\"text-align: justify;\">Howard JT et al. Military use of tranexamic acid in combat trauma: Does it matter? J Trauma Acute Care Surg 2017; 83:579-88<br \/>\n\u201eA total of 3,773 casualties were included in this retrospective, observational study of data gathered from a\u00a0trauma The total sample, along with three subsamples for massive transfusion patients (n = 784), propensity-matched sample (n = 1,030), and US\/North Atlantic Treaty Organization (NATO)\u00a0military(n = 1,262), was assessed for administration of TXA and time from injury to administration of TXA. Outcomes included mortality and occurrence of pulmonary embolism and deep vein thrombosis. Multivariable proportional hazards regression models with robust standard error estimates were used to estimate hazard ratios (HR) for assessment of outcomes while controlling for covariates. \u2026 Results of univariate and multivariate analyses of the total sample (HR, 0.97; 95% confidence interval [CI], 0.62-1.53; p = 0.86), massive transfusion sample (HR, 0.84; 95% CI, 0.46-1.56; p = 0.51), propensity-matched sample (HR, 0.68; 95% CI, 0.27-1.73; p = 0.34), and US\/NATO\u00a0military\u00a0sample (HR, 0.76; 95% CI, 0.30-1.92; p = 0.48) indicate no statistically significant association between TXA use and mortality. Use of TXA was associated with increased risk of pulmonary embolism in the total sample (HR, 2.82; 95% CI, 2.08-3.81; p &lt; 0.001), massive transfusion sample (HR, 3.64; 95% CI, 1.96-6.78; p = 0.003), US\/NATO\u00a0military\u00a0sample (HR, 2.55; 95% CI, 1.73-3.69; p = 0.002), but not the propensity-matched sample (HR, 3.36; 95% CI, 0.80-14.10; p = 0.10). TXA was also associated with increased risk of deep vein thrombosis in the total sample (HR, 2.00; 95% CI, 1.21-3.30; p = 0.02) and US\/NATO\u00a0military\u00a0sample (HR, 2.18; 95% CI, 1.20-3.96; p = 0.02).<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Es mehren sich damit die Hinweise, dass TXA zwar oft mit einer verbesserten Sterblichkeit korreliert, aber eben auch und gerade bei Schwerstverletzten (die derzeit die Hauptindikation sind) zu thromboembolischen Komplikationen f\u00fchren kann. Die in CRASH-2 geschilderten 369 thromboembolische Komplikationen (Myokardinfarkt, Schlaganfall, Lungenembolie, tiefe Venenthrombose) bei &gt; 20.000 Patienten werden von den Autoren der Studie selbst als unglaubw\u00fcrdig angesehen.<\/p>\n<hr \/>\n<p>Freuen Sie sich auf teil der Serie &#8222;TXA &#8211; Nicht mit der Giesskanne&#8220;.<\/p>\n<hr \/>\n<p><strong><a href=\"https:\/\/twitter.com\/news_papers_eu?refsrc=email&amp;s=11\" target=\"_blank\" rel=\"noopener noreferrer\">News-Papers.eu auf TWITTER<\/a>\u00a0 \u00a0 \u00a0 \u00a0\u00a0<a href=\"http:\/\/news-papers.eu\/follow\" target=\"_blank\" rel=\"noopener noreferrer\">Follow news-papers.eu<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nun\u00a0Teil 2 des gemeinsamen Beitrages von Dr. Heiko Lier, K\u00f6ln\/Deutschland und PD Dr. J\u00fcrgen Knapp, Bern Schweiz: Wie aus den Daten der oben zitierten Arbeit von Moore et al. hervorgeht, [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":7238,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[1210],"tags":[186,184],"class_list":["post-7233","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blutungsmanagement","tag-blutung","tag-txa"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/05\/Bildschirmfoto-2018-03-31-um-12.50.32-e1522493478145.png?fit=300%2C197","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-1SF","jetpack-related-posts":[{"id":7231,"url":"http:\/\/news-papers.eu\/?p=7231","url_meta":{"origin":7233,"position":0},"title":"TXA \u2013 nicht mit der Gie\u00dfkanne! Teil 1","author":"Michael Bernhard","date":"Mai 17, 2018","format":false,"excerpt":"Es ist mal wieder Zeit\u00a0f\u00fcr eine Serien: Hier nun Teil 1 eines gemeinsamen Beitrages von Dr. Heiko Lier, K\u00f6ln\/Deutschland und PD Dr. J\u00fcrgen Knapp, Bern Schweiz: Vermutlich basierend auf den zwei gro\u00dfen Studien zum Nutzen der Tranexams\u00e4ure (TXA) bei (vermuteter) massiver Blutung beim Trauma-Patienten (CRASH-2 trial) bzw. bei der peripartalen\u2026","rel":"","context":"In &quot;Blutungsmanagement&quot;","block_context":{"text":"Blutungsmanagement","link":"http:\/\/news-papers.eu\/?cat=1210"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/05\/Bildschirmfoto-2018-03-31-um-12.50.32-300x197.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":3014,"url":"http:\/\/news-papers.eu\/?p=3014","url_meta":{"origin":7233,"position":1},"title":"Sind wir zu gro\u00dfz\u00fcgig mit der Gabe von Tranexams\u00e4ure?","author":"Bj\u00f6rn Hossfeld","date":"Dezember 4, 2016","format":false,"excerpt":"Infolge der CRASH-2-Studie und der Darstellung der Ergebnisse dahin gehend, dass der gr\u00f6\u00dfte Effekt auf das Outcome erzielt w\u00fcrde, wenn Tranexams\u00e4ure (TXA) dem blutenden Traumapatienten bereits in der ersten Stunde nach Trauma appliziert w\u00fcrde, um eine traumainduzierte Hyperfibrinolyse zu verhindern, konnte in den letzten Jahren eine deutliche Steigerung der pr\u00e4hospitalen\u2026","rel":"","context":"In &quot;Trauma&quot;","block_context":{"text":"Trauma","link":"http:\/\/news-papers.eu\/?cat=6"},"img":{"alt_text":"rotem hyperfibrinolyse","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/ROTEM_Hyperfibrinolyse-1024x644.png?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/ROTEM_Hyperfibrinolyse-1024x644.png?resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/ROTEM_Hyperfibrinolyse-1024x644.png?resize=525%2C300 1.5x"},"classes":[]},{"id":7235,"url":"http:\/\/news-papers.eu\/?p=7235","url_meta":{"origin":7233,"position":2},"title":"TXA \u2013 nicht mit der Gie\u00dfkanne! Teil 3","author":"Michael Bernhard","date":"Mai 21, 2018","format":false,"excerpt":"Fortsetzung Teil 3 eines gemeinsamen Beitrag von Dr. Heiko Lier, K\u00f6ln\/Deutschland und PD Dr. J\u00fcrgen Knapp, Bern Schweiz: Teil 1 & Teil 2 Nicht vergessen werden darf auch, dass sich die Patienten sowohl in der CRASH-2-Studie als auch im WOMAN trial zum Gro\u00dfteil aus Entwicklungs- oder Schwellenl\u00e4ndern rekrutierten. Im WOMAN\u2026","rel":"","context":"In &quot;Blutungsmanagement&quot;","block_context":{"text":"Blutungsmanagement","link":"http:\/\/news-papers.eu\/?cat=1210"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/05\/Bildschirmfoto-2018-03-31-um-12.50.32-300x197.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":18285,"url":"http:\/\/news-papers.eu\/?p=18285","url_meta":{"origin":7233,"position":3},"title":"Tranexams\u00e4ure und intracranielle Blutung","author":"Bj\u00f6rn Hossfeld","date":"Mai 7, 2024","format":false,"excerpt":"Ein Gastbeitrag von H. Lier, K\u00f6ln.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Weltweit erleiden pro Jahr rund 3,4 Millionen Patienten eine intrakranielle Blutung (ICB); dies f\u00fchrt j\u00e4hrlich zu rund 2,89 Mio. Todesf\u00e4llen [10]: damit ist die ICB ist f\u00fcr etwa 5% der j\u00e4hrlichen Todesf\u00e4lle weltweit [5] verantwortlich. Bei einer ICB korreliert das Ausma\u00df der H\u00e4matomzunahme unabh\u00e4ngig\u2026","rel":"","context":"In &quot;Blutstillung&quot;","block_context":{"text":"Blutstillung","link":"http:\/\/news-papers.eu\/?cat=4"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2024\/05\/ICB.jpg?fit=1200%2C1159&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2024\/05\/ICB.jpg?fit=1200%2C1159&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2024\/05\/ICB.jpg?fit=1200%2C1159&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2024\/05\/ICB.jpg?fit=1200%2C1159&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2024\/05\/ICB.jpg?fit=1200%2C1159&resize=1050%2C600 3x"},"classes":[]},{"id":10238,"url":"http:\/\/news-papers.eu\/?p=10238","url_meta":{"origin":7233,"position":4},"title":"Tranexams\u00e4ure, alles klar ? Nein!","author":"Michael Bernhard","date":"Oktober 12, 2019","format":false,"excerpt":"Die Publikation von CRASH-2 [1] f\u00fchrte ab 2010 weltweit zu einer Renaissance eines bereits 1962 [2] erstmals erw\u00e4hnten Medikamentes: Tranexams\u00e4ure (TXA). In der folgenden Dekade wurden rund 3.000 Publikationen zum Thema in PubMed gelistet. W\u00e4hrend in den USA und Australien \/ Neuseeland vereinzelt kritischen Artikel erschienen (z.B. [3]), wurde TXA\u2026","rel":"","context":"In &quot;Blutungsmanagement&quot;","block_context":{"text":"Blutungsmanagement","link":"http:\/\/news-papers.eu\/?cat=1210"},"img":{"alt_text":"TXA","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/TXA-215x300.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":12808,"url":"http:\/\/news-papers.eu\/?p=12808","url_meta":{"origin":7233,"position":5},"title":"TXA bei SHT? &#8211; die Dritte\u2026.","author":"Michael Bernhard","date":"Januar 1, 2021","format":false,"excerpt":"Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz:\u00a0 Nach den hei\u00df diskutierten Ergebnissen der CRASH-3-Studie zum Nutzen der Tranexams\u00e4ure (TXA) von vor 1 Jahr und den im September 2020 ver\u00f6ffentlichten Daten von Rowell et al., die keinen Vorteil durch die Gabe von TXA bei Sch\u00e4del-Hirn-Trauma (SHT)-Patienten fand, liegen uns nun\u2026","rel":"","context":"In &quot;Blutungsmanagement&quot;","block_context":{"text":"Blutungsmanagement","link":"http:\/\/news-papers.eu\/?cat=1210"},"img":{"alt_text":"TXA","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/TXA-215x300.jpg?resize=350%2C200","width":350,"height":200},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/7233","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7233"}],"version-history":[{"count":3,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/7233\/revisions"}],"predecessor-version":[{"id":7243,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/7233\/revisions\/7243"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/media\/7238"}],"wp:attachment":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7233"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7233"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7233"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}