Kammerer, Tobias ORCID: 0000-0001-8920-7187, Groene, Philipp, Sappel, Sophia R., Peterss, Sven, Sa, Paula A., Saller, Thomas, Giebl, Andreas, Scheiermann, Patrick, Hagl, Christian and Schaefer, Simon Thomas ORCID: 0000-0001-7289-6000 . Functional Testing for Tranexamic Acid Duration of Action Using Modified Viscoelastometry. Transfus. Med. Hemother.. BASEL: KARGER. ISSN 1660-3818

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Abstract

Introduction: Tranexamic acid (TXA) is the standard medication to prevent or treat hyperfibrinolysis. However, prolonged inhibition of lysis (so-called fibrinolytic shutdown) correlates with increased mortality. A new viscoelastometric test enables bedside quantification of the antifibrinolytic activity of TXA using tissue plasminogen activator (TPA). Materials and Methods: Twenty-five cardiac surgery patients were included in this prospective observational study. In vivo, the viscoelastometric TPA test was used to determine lysis time (LT) and maximum lysis (ML) over 96 h after TXA bolus. Additionally, plasma concentrations of TXA and plasminogen activator inhibitor 1 (PAI-1) were measured. Moreover, dose effect curves from the blood of healthy volunteers were performed in vitro. Data are presented as median (25-75th percentile). Results: In vivo TXA plasma concentration correlated with LT (r = 0.55; p < 0.0001) and ML (r = 0.62; p < 0.0001) at all time points. Lysis was inhibited up to 96 h (LTTPA-test: baseline: 398 s [229-421 s] vs. at 96 h: 886 s [626-2,175 s]; p = 0.0013). After 24 h, some patients (n = 8) had normalized lysis, but others (n = 17) had strong lysis inhibition (ML p < 0.001). The high- and low-lysis groups differed regarding kidney function (cystatin C: 1.64 [1.42-2.02] vs. 1.28 [1.01-1.52] mg/L; p = 0.002) in a post hoc analysis. Of note, TXA plasma concentration after 24 h was significantly higher in patients with impaired renal function (9.70 [2.89-13.45] vs.1.41 [1.30-2.34] mu g/mL; p < 0.0001). In vitro, TXA concentrations of 10 mu g/mL effectively inhibited fibrinolysis in all blood samples. Conclusions: Determination of antifibrinolytic activity using the TPA test is feasible, and individual fibrinolytic capacity, e.g., in critically ill patients, can potentially be measured. This is of interest since TXA-induced lysis inhibition varies depending on kidney function.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kammerer, TobiasUNSPECIFIEDorcid.org/0000-0001-8920-7187UNSPECIFIED
Groene, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sappel, Sophia R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Peterss, SvenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sa, Paula A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saller, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Giebl, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Scheiermann, PatrickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagl, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schaefer, Simon ThomasUNSPECIFIEDorcid.org/0000-0001-7289-6000UNSPECIFIED
URN: urn:nbn:de:hbz:38-311855
DOI: 10.1159/000511230
Journal or Publication Title: Transfus. Med. Hemother.
Publisher: KARGER
Place of Publication: BASEL
ISSN: 1660-3818
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
FIBRINOLYSIS SHUTDOWN; CARDIAC-SURGERY; BLOOD MANAGEMENT; HYPERFIBRINOLYSIS; MORTALITY; SOCIETY; RISK; METAANALYSISMultiple languages
Hematology; ImmunologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/31185

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