RESUMO
A recent large civilian randomized controlled trial on the use of tranexamic acid (TXA) for trauma reported important survival benefits. Subsequently, successful use of TXA for combat casualties in Afghanistan was also reported. As a result of these promising studies, there has been growing interest in the use of TXA for trauma. Potential adverse effects of TXA have also been reported. A US Department of Defense committee conducted a review and assessment of knowledge gaps and research requirements regarding the use of TXA for the treatment of casualties that have experienced traumatic hemorrhage. We present identified knowledge gaps and associated research priorities. We believe that important knowledge gaps exist and that a targeted, prioritized research effort will contribute to the refinement of practice guidelines over time.
Assuntos
Antifibrinolíticos/uso terapêutico , Hemorragia/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Ferimentos e Lesões/tratamento farmacológico , Antifibrinolíticos/farmacologia , Humanos , Complicações Pós-Operatórias/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Pesquisa , Fatores de Risco , Convulsões/induzido quimicamente , Trombose/induzido quimicamente , Ácido Tranexâmico/farmacologia , Ferimentos e Lesões/cirurgiaRESUMO
OBJECTIVE: The hypothermia and hemostasis in severe trauma (HYPOSTAT): a new crossroads workshop was convened to evaluate the interplay among hypothermia, hemostasis, and severe trauma/hemorrhage. Trauma is the major cause of death in young individuals in the United States, with uncontrolled hemorrhage representing the major cause of preventable deaths. DATA SOURCES: This workshop organized by the National Heart, Lung, and Blood Institute and the US Army Medical Research and Material Command as a forum for exchange of ideas among experts from diverse fields. The specific workshop goals were to (1) identify state-of-the-art and needs in knowledge of biology of hypothermia and hemostasis in the setting of significant traumatic injury; (2) provide an interdisciplinary forum to enhance knowledge regarding early detection of traumatic shock and monitoring of the level and effect of controlled hypothermia in severe trauma settings; and (3) identify future research directions of the role of therapeutic-oriented hypothermia and hemostasis in trauma with severe blood loss. STUDY SELECTION: Not applicable. DATA EXTRACTION: Expert opinion and literature review. CONCLUSION: This document provides a summary of the expert opinion and highlights the recommendations that came out of the discussions at this workshop to guide scientific efforts in basic, translational, and clinical research in this area.
