Universität zu Köln

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:	Creators Email ORCID ORCID Put Code Kammerer, Tobias UNSPECIFIED orcid.org/0000-0001-8920-7187 UNSPECIFIED Groene, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Sappel, Sophia R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Peterss, Sven UNSPECIFIED UNSPECIFIED UNSPECIFIED Sa, Paula A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Saller, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Giebl, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheiermann, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Hagl, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Simon Thomas UNSPECIFIED orcid.org/0000-0001-7289-6000 UNSPECIFIED
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:	Keywords Language FIBRINOLYSIS SHUTDOWN; CARDIAC-SURGERY; BLOOD MANAGEMENT; HYPERFIBRINOLYSIS; MORTALITY; SOCIETY; RISK; METAANALYSIS Multiple languages Hematology; Immunology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31185