{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:23:30Z","timestamp":1778541810432,"version":"3.51.4"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Defense Health Program"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2024,10,5]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Non-compressible torso hemorrhage (NCTH) represents a leading cause of preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) stabilizes NCTH but may predispose patients to thrombus generation. REBOA must therefore be prospectively evaluated for coagulation risks with concomitant usage of anti-fibrinolytic tranexamic acid (TXA). Using a porcine model of hemorrhage, it was hypothesized that TXA with REBOA would worsen coagulation outcomes and organ damage.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and methods<\/jats:title>\n                  <jats:p>Thirty-two male Yorkshire swine underwent 30% blood volume hemorrhage with randomization to vehicle control (VC; normal saline), VC+REBOA, TXA, or TXA+REBOA. At T0, animals received 10\u2009mL\/minute of group-specific infusion (GSI) followed at T10 by 500\u2009mL of whole blood (WB), second GSI at 13\u2009mL\/hour, and Zone 1 REBOA inflation in REBOA groups. At T40, REBOA was deflated, with additional 500\u2009mL WB, and continuation of GSI for 3\u2009hours. Physiological, coagulation, and inflammatory parameters were measured throughout the protocol, with postmortem histopathology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After REBOA deflation at T40, lactate was significantly higher for the REBOA groups versus the non-REBOA groups, and pH, bicarbonate, and base excess were all significantly lower than the non-REBOA groups. There were no significant differences observed between groups in coagulation, inflammatory, metabolic, or histopathologic parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Administration of TXA with REBOA did not cause more deleterious coagulation outcomes. All significant changes were expected results of REBOA ischemia, and not attributable to TXA treatment. This suggests NCTH can safely be treated with both hemorrhage control methods without exacerbating clotting outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Not applicable\u2014basic animal research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001559","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T11:55:28Z","timestamp":1738065328000},"page":"e001559","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Tranexamic acid as an adjunct to resuscitative endovascular balloon occlusion of the aorta does not worsen outcomes in a porcine model of hemorrhage"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6561-6274","authenticated-orcid":false,"given":"Leslie E","family":"Neidert","sequence":"first","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clifford G","family":"Morgan","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic","family":"Lonowski","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Castro","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J","family":"Hemond","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria R","family":"Lozano","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M","family":"Tiller","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"},{"name":"Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvain","family":"Cardin","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob J","family":"Glaser","sequence":"additional","affiliation":[{"name":"Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA"},{"name":"Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"2025082410260414000_10.1.e001559.1","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1097\/TA.0b013e318221147b","article-title":"Died of Wounds on the Battlefield: Causation and Implications for Improving Combat Casualty Care","volume":"71","author":"Eastridge","year":"2011","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182755dcc"},{"key":"2025082410260414000_10.1.e001559.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.05.099"},{"key":"2025082410260414000_10.1.e001559.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2012.04.035"},{"key":"2025082410260414000_10.1.e001559.5","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/TA.0b013e31827a3704","article-title":"The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan","volume":"74","author":"Stannard","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.6","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.jemermed.2019.03.030","article-title":"Resuscitative Endovascular Balloon Occlusion of the Aorta: A Review for Emergency Clinicians","volume":"56","author":"Long","year":"2019","journal-title":"J Emerg Med"},{"key":"2025082410260414000_10.1.e001559.7","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1097\/TA.0000000000001665","article-title":"Time to aortic occlusion: It\u2019s all about access","volume":"83","author":"Romagnoli","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.8","doi-asserted-by":"publisher","DOI":"10.3310\/hta17370"},{"key":"2025082410260414000_10.1.e001559.9","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2011.287"},{"key":"2025082410260414000_10.1.e001559.10","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0140-6736(17)32455-8","article-title":"Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40\u2008138 bleeding patients","volume":"391","author":"Gayet-Ageron","year":"2018","journal-title":"The Lancet"},{"key":"2025082410260414000_10.1.e001559.11","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1001\/jamasurg.2013.764","article-title":"Association of cryoprecipitate and tranexamic acid with improved survival following wartime injury: findings from the MATTERs II Study","volume":"148","author":"Morrison","year":"2013","journal-title":"JAMA Surg"},{"key":"2025082410260414000_10.1.e001559.12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.55460\/7U98-J4HL","article-title":"Prehospital Administration of Tranexamic Acid by Ground Forces in Afghanistan: The Prehospital Trauma Registry Experience","volume":"17","author":"Schauer","year":"2017","journal-title":"J Spec Oper Med"},{"key":"2025082410260414000_10.1.e001559.13","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.jemermed.2019.08.027","article-title":"An Analysis of Adherence to Tactical Combat Casualty Care Guidelines for the Administration of Tranexamic Acid","volume":"57","author":"Fisher","year":"2019","journal-title":"J Emerg Med"},{"key":"2025082410260414000_10.1.e001559.14","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/TA.0000000000002061","article-title":"Tranexamic acid administration is associated with an increased risk of posttraumatic venous thromboembolism","volume":"86","author":"Myers","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.15","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2019-000353","article-title":"TXA (Tranexamic Acid) Risk Evaluation in Combat Casualties (TRECC)","volume":"5","author":"Adair","year":"2020","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025082410260414000_10.1.e001559.16","unstructured":"Committee on Trauma . Advanced trauma life support (atls) student course manual. 10th edn. American College of Surgeons, 2018."},{"key":"2025082410260414000_10.1.e001559.17","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.surg.2009.05.006","article-title":"Females have fewer complications and lower mortality following trauma than similarly injured males: a risk adjusted analysis of adults in the National Trauma Data Bank","volume":"146","author":"Haider","year":"2009","journal-title":"Surgery"},{"key":"2025082410260414000_10.1.e001559.18","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1017\/S1049023X23006428","article-title":"Epidemiology of Trauma-Related Hemorrhage and Time to Definitive Care Across North America: Making the Case for Bleeding Control Education","volume":"38","author":"Jones","year":"2023","journal-title":"Prehosp Disaster Med"},{"key":"2025082410260414000_10.1.e001559.19","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/TA.0000000000003024","article-title":"Therapeutic cardiac arrest as an adjunct to resuscitative endovascular balloon occlusion of the aorta: Bridging the gap from fatal hemorrhage to definitive surgical control in swine","volume":"90","author":"Stigall","year":"2021","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.20","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1097\/TA.0000000000003894","article-title":"REBOA for the Treatment of Blast Polytrauma: Zone 3 Provides Cerebral Perfusion, Attenuates Organ Dysfunction and Reperfusion Coagulopathy Compared to Zone 1 in a Swine Model","volume":"94","author":"Cralley","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.21","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1016\/j.jss.2011.10.005","article-title":"Hypercoagulability in porcine hemorrhagic shock is present early after trauma and resuscitation","volume":"174","author":"Mulier","year":"2012","journal-title":"J Surg Res"},{"key":"2025082410260414000_10.1.e001559.22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s13613-021-00871-z","article-title":"Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine","volume":"11","author":"Hutin","year":"2021","journal-title":"Ann Intensive Care"},{"key":"2025082410260414000_10.1.e001559.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2012.12.001"},{"key":"2025082410260414000_10.1.e001559.24","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/TA.0000000000002749","article-title":"Resuscitative endovascular balloon occlusion of the aorta for thoracic trauma: A translational swine study","volume":"89","author":"Glaser","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.25","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1097\/TA.0b013e31822114af","article-title":"Tranexamic Acid for Trauma Patients: A Critical Review of the Literature","volume":"71","author":"Cap","year":"2011","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.26","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","article-title":"Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial","volume":"389","author":"Shakur","year":"2017","journal-title":"The Lancet"},{"key":"2025082410260414000_10.1.e001559.27","article-title":"Resuscitative Endovascular Balloon Occlusion of the Aorta and Concomitant Tranexamic Acid for Cesarean Hysterectomy Complicated by Common Femoral Artery Thrombosis: A Case Report","volume":"12","author":"Herbert","year":"2020","journal-title":"Cureus"},{"key":"2025082410260414000_10.1.e001559.28","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1213\/XAA.0000000000000535","article-title":"Aortoiliac Thrombosis Following Tranexamic Acid Administration During Urgent Cesarean Hysterectomy","volume":"9","author":"Hajmurad","year":"2017","journal-title":"A & A Case Reports"},{"key":"2025082410260414000_10.1.e001559.29","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/TA.0000000000003440","article-title":"Life over limb: Arterial access-related limb ischemic complications in 48-hour REBOA survivors","volume":"92","author":"Laverty","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.30","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/MBC.0000000000000983","article-title":"The incidence of venous thromboembolic events in trauma patients after tranexamic acid administration: an EAST multicenter study","volume":"32","author":"Rivas","year":"2021","journal-title":"Blood Coagul Fibrinolysis"},{"key":"2025082410260414000_10.1.e001559.31","doi-asserted-by":"crossref","first-page":"e2932","DOI":"10.1093\/milmed\/usac317","article-title":"A Systematic Review of Tranexamic Acid-Associated Venous Thromboembolic Events in Combat Casualties and Considerations for Prolonged Field Care","volume":"188","author":"Russo","year":"2023","journal-title":"Mil Med"},{"key":"2025082410260414000_10.1.e001559.32","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1097\/TA.0000000000002882","article-title":"Resuscitative endovascular balloon occlusion of the aorta for thoracic trauma in the setting of platelet dysfunction: A translational swine study","volume":"89","author":"Glaser","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.33","first-page":"169","article-title":"Monitoring Organs Susceptible to Ischemia\/Reperfusion Injury after Prolonged Resuscitative Endovascular Balloon Occlusion of the Aorta in a Hemorrhagic Shock Swine Model","volume":"9","author":"Scalea","year":"2020","journal-title":"Panam J Trauma Crit Care Emerg Surg"},{"key":"2025082410260414000_10.1.e001559.34","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/TA.0000000000000860","article-title":"Double-blinded, placebo-controlled study of early tranexamic acid treatment in swine uncontrolled hemorrhage model","volume":"80","author":"Sondeen","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410260414000_10.1.e001559.35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12959-021-00303-9","article-title":"Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review","volume":"19","author":"Ockerman","year":"2021","journal-title":"Thrombosis J"},{"key":"2025082410260414000_10.1.e001559.36","unstructured":"Glaser J , Stigall K , Cannon J , et al . Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for hemorrhagic shock (CPG ID: 38). J T S Clin Pract Guideline 2020:1\u201328."}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2024-001559","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:26:17Z","timestamp":1756056377000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2024-001559"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,28]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/tsaco-2024-001559"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2024-001559","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}