Zusammenfassung
In der klinischen Betrachtung wird die Tranexamsäure (TXA) von vielen Therapeuten
als eine Art „Magic Bullet“ bei der präklinischen Behandlung von schwer blutenden
Patienten gesehen. Obwohl durch Leitlinien angeraten, wird die generelle Verwendung
der TXA im Rahmen des zeitlichen Aspekts der Applikation als auch im Zusammenhang
mit speziellen traumaassoziierten Krankheitsbildern wie der traumainduzierten Koagulopathie
(TIK) zunehmend kritisch diskutiert.
Abstract
The early use of tranexamic acid (TXA) has become more and more popular during the
last couple of years. Some therapists even see it as a kind of “magic bullet” for
preclinical treatment of massive hemorrhage. The primary goal is to use TXAʼs procoagulant
characteristics by inhibition of the fibrinolytic system by intravenous administration
of TXA (1 g), thus reducing the need of blood transfusion. Already on arrival in the
emergency department, coagulation is limited in ⅓ of the patients, but most of them
show a fibrinolysis shutdown, not a hyperfibrinolysis. Although recommended by guidelines,
the general use of tranexamic acid in the context of the temporal aspect of the application,
as well as in connection with special trauma-associated diseases, such as trauma-induced
coagulopathy (TIC) is increasingly critically discussed. Viscoelastic testing procedures
like thromboelastography or ROTEM become more and more important in diagnostics and
seem to be a good option in acute care of patients with traumatic hemorrhage. This
article tries to summarize the current state of knowledge and to sensitize emergency
physicians in their therapy with TXA.
Schlüsselwörter
Tranexamsäure - präklinische Versorgung - Hyperfibrinolyse - Fibrinolyse-Shutdown
Key words
tranexamic acid - prehospital treatment - hyperfibrinolysis - fybrinolysis shutdown
