86 Haemodynamic effects of the enteral administration of tranexamic acid in an experimental model of haemorrhagic shock. (16th April 2018)

• Record Type: Journal Article
• Authors: Babini, G; Olivari, D; de Giorgio, D; Staszewsky, L; Latini, R; Ristagno, G
• Is Part Of: BMJ open. Volume 8:Supplement 1(2018)
• Page Start: A32
• Page End: A33
• Publication Date: 2018-04-16
• Subjects: Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-EMS.86
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Aim: Systemic proteolysis has been proposed as part of the complex pathologic events occurring during haemorrhagic shock (HS). Hypoperfusion may increase permeability of the gut mucosa, promoting intestinal proteases translocation into the circulation and multiorgan failure ('autodigestion hypothesis'). 1 The interruption of this cascade of events may improve systemic perfusion and organ functions. Method: The present study investigated the effects of the enteral administration of a protease inhibitor, i.e. tranexamic acid (TXA), on hemodynamics in a porcine model of controlled severe acute bleeding, fluid resuscitation and blood transfusion. Six animals underwent HS without any treatment while five animals were treated with enteral TXA. Results: Baseline measurements were similar in both HS and TXA groups. Both groups showed a significant reduction in mean arterial pressure (MAP) after bleeding compared to baseline values, however at the end of the fluid resuscitation MAP was significantly higher in the TXA group (62.67±13.17 vs 92.20±22.35 mmHg, p<0.01). Echocardiographic stroke volume (SV) and left ventricle ejection fraction (LVEF) were higher in the TXA group at the end of both fluid resuscitation and blood transfusion phases (SV: 32.42±5.83 vs 45.23%±13.76% and 35.11±14.62 vs 43.68%±13.92%, p not significant; LVEF: 65.9±5.3 vs 77.8%±4.7%, p=0.05 and 61.5±8.2 vs 76.3%±4.3%, p<0.01). No significant differences were observed in mixed venous saturation (SvO2) and lactate levels, despite SvO2 remained higher in the TXA group throughout the experiment except at baseline. Conclusion: In this experimental model of HS the enteral administration of TXA was associated with a global improvement in hemodynamics; however, only small benefits were observed on mixed venous saturation and lactate levels. Reference: . Schmid-Schönbein GW. 2008landis award lecture. Inflammation and the autodigestion hypothesis. Microcirculation 2009;16(4):289–306. Conflict of interest: None Funding: None