Plasma Co-Administration Improves Resuscitation with Tranexamic Acid or Prothrombin Complex in a Porcine Hemorrhagic Shock Model

BACKGROUND Traumatic coagulopathy has now been well characterized and carries high rates of mortality due to bleeding. A "factor-based" resuscitation strategy using pro-coagulant drugs and factor concentrates in lieu of plasma is being used by some, but with little evidentiary support. We sought to evaluate and compare resuscitation strategies using combinations of tranexamic acid (TXA), prothrombin complex concentrate (PCC), and fresh frozen plasma (FFP). METHODS 60 adult swine underwent 35% blood volume hemorrhage combined with a truncal ischemia-reperfusion injury to produce uniform shock and coagulopathy. Animals were randomized to control (N=12), a single agent group (TXA, N=10, PCC, N=8, or FFP, N=6) or combination groups (TXA-FFP, N=10, PCC-FFP, N=8, TXA-PCC, N=6). Resuscitation was continued to 6 hours. Key outcomes included hemodynamics, lab values, and rotational thromboelastometry (ROTEM). Results were compared between all groups, with additional comparisons between FFP and non-FFP groups. RESULTS All 60 animals survived to 6 hours. Shock was seen in all animals, with hypotension (MAP 44mmHg), tachycardia (HR 145), acidosis (pH 7.18, lactate 11), anemia (HCT 17), and coagulopathy (Fibrinogen 107). There were clear differences between groups for mean pH (p=0.02), INR (p

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