Early Tranexamic Acid Administration After Traumatic Brain Injury Is Associated With Reduced Syndecan-1 and Angiopoietin-2 in Patients With Traumatic Intracranial Hemorrhage.
J Head Trauma Rehabil
; 35(5): 317-323, 2020.
Article
en En
| MEDLINE
| ID: mdl-32881765
ABSTRACT
OBJECTIVE:
To evaluate the effect of early tranexamic acid (TXA) administration on circulating markers of endotheliopathy.SETTING:
Twenty trauma centers in the United States and Canada.PARTICIPANTS:
Patients with moderate-to-severe traumatic brain injury (TBI) (MS-TBI) and intracranial hemorrhage who were not in shock (systolic blood pressure ≥90 mm Hg).DESIGN:
TXA (2 g) or placebo administered prior to hospital arrival, less than 2 hours postinjury. Blood samples and head computed tomographic scan collected upon arrival. Plasma markers measured using Luminex analyte platform. Differences in median marker levels evaluated using t tests performed on log-transformed variables. Comparison groups were TXA versus placebo and less than 45 minutes versus 45 minutes or more from time of injury to treatment administration. MAINMEASURES:
Plasma levels of angiopoietin-1, angiopoietin-2, syndecan-1, thrombomodulin, thrombospondin-2, intercellular adhesion molecule 1, vascular adhesion molecule 1.RESULTS:
Demographics and Injury Severity Score were similar between the placebo (n = 129) and TXA (n = 158) groups. Levels of syndecan-1 were lower in the TXA group (median [interquartile range or IQR] = 254.6 pg/mL [200.7-322.0] vs 272.4 pg/mL [219.7-373.1], P = .05. Patients who received TXA less than 45 minutes postinjury had significantly lower levels of angiopoietin-2 (median [IQR] = 144.3 pg/mL [94.0-174.3] vs 154.6 pg/mL [110.4-209.8], P = .05). No differences were observed in remaining markers.CONCLUSIONS:
TXA may inhibit early upregulation of syndecan-1 and angiopoietin-2 in patients with MS-TBI, suggesting attenuation of protease-mediated vascular glycocalyx breakdown. The findings of this exploratory analysis should be considered preliminary and require confirmation in future studies.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Ácido Tranexámico
/
Hemorragia Intracraneal Traumática
/
Angiopoyetina 2
/
Sindecano-1
/
Lesiones Traumáticas del Encéfalo
/
Antifibrinolíticos
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Head Trauma Rehabil
Asunto de la revista:
REABILITACAO
/
TRAUMATOLOGIA
Año:
2020
Tipo del documento:
Article