TRAUMA-ASSOCIATED COAGULOPATHY AND ANTIFIBRINOLYTIC THERAPY : A BATTLE AGAINST TIME

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 34; no. 2; pp. 27 - 34
• Main Authors: 久志本 成樹, 工藤 大介
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 12.05.2020; The Japanese Association for the Surgery of Trauma
• Subjects: surgery; tranexamic acid; trauma; traumatic coagulopathy; トラネキサム酸; 外傷; 外傷性凝固障害; 手術
• ISSN: 1340-6264; 2188-0190
• DOI: 10.11382/jjast.34.2_01

Hemorrhage is the most important factor for acute-phase mortality in trauma patients, and our understanding of coagulopathy in patients with severe trauma has markedly improved. Although the pathophysiology of trauma-associated coagulation impairment has not been clarified, trauma itself and/or the traumatic shock-induced fibrinolytic condition is referred to as acute traumatic coagulopathy, and multifactorial trauma-associated coagulation impairment, including acute traumatic coagulopathy and resuscitation-associated coagulopathy, is recognized as trauma-induced coagulopathy. Prevention and management of traumatic coagulopathy based on the scientific background of trauma-induced coagulopathy are core strategic components. Tranexamic acid, a widely used antifibrinolytic agent, is one core component in the management of acute traumatic coagulopathy. Recognition of recent evidence regarding the effectiveness and usefulness of tranexamic acid in patients with trauma, and a clear understanding that “traumatic-associated coagulopathy and antifibriolytic therapy is a battle against time” are essential in trauma care. 　外傷患者の急性期死亡原因としての出血はきわめて重要であり, 外傷急性期凝固異常との病態の存在は広く認識されている. そのメカニズムは必ず明確ではないが, 外傷とこれに伴うショックにより惹起される線溶亢進病態であるacute traumatic coagulopathy, 治療に関わる因子が加わり形成されるtrauma-induced coagulopathyがこれらを形成する. 凝固障害の回避と治療であるdamage control resuscitationを根拠に基づき行うことは, 重症外傷に対する中心的治療戦略である. 線溶反応を制御するトラネキサム酸は, acute traumatic coagulopathyに対する治療の中心要素のひとつである. 多くの凝固異常対策とともに行うトラネキサム酸投与の有効性と有用性, さらに "時を争う病態と治療" との認識は, 外傷医として求められる臨床課題である.