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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Tranexamic acid use in severely injured patients, is it always appropriate?
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Vol. 68. Issue 5.
Pages 301-303 (May 2021)
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Vol. 68. Issue 5.
Pages 301-303 (May 2021)
Case report
DOI: 10.1016/j.redare.2020.06.016
Tranexamic acid use in severely injured patients, is it always appropriate?
Ácido tranexámico en el paciente politraumatizado grave, ¿está siempre indicado?
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P. Duque
Corresponding author
patriduque@gmail.com

Corresponding author.
, L. Gonzalez-Zarco, R. Martínez, S. Gago, J.A. Varela
Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Abstract

Recently, it has been suggested that tranexamic acid should be administered only in those patients with hyperfibrinolysis determined using viscoelastic assays, as severely injured patients may present with fibrinolytic shutdown. However the last European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results. We present a severely blunt trauma patient treated with on-scene administration of tranexamic acid that developed immediate pulmonary embolism.

Keywords:
Multiple trauma
Tranexamic acid
Hyperfibrinolysis
Fibrinolysis shutdown
Pulmonary embolism
Resumen

Recientemente se ha sugerido la administración de ácido tranexámico sólo en aquellos pacientes con hiperfibrinólisis documentada con métodos viscoelásticos, ya que los pacientes politraumatizados graves pueden presentar una disminución de la fibrinólisis. Sin embargo, las últimas guías clínicas sobre el manejo de la hemorragia y coagulopatía tras un trauma recomiendan el uso de ácido tranexámico en todo paciente sangrante, o con posibilidad de sangrar, lo más precozmente posible sin esperar los resultados de los métodos viscoelásticos. Presentamos el caso de un trauma cerrado grave que recibió ácido tranexámico prehospitalariamente y desarrolló un embolismo pulmonar inmediato.

Palabras clave:
Politraumatizado
Ácido tranexámico
Hiperfibrinólisis
Fibrinólisis disminuida
Tromboembolismo pulmonar

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