Efficacy of prehospital administration of tranexamic acid in trauma patients
A meta-analysis of the randomized controlled trials: The American Journal of Emergency Medicine
Trauma remains a leading cause of death worldwide, and the management of injured patients at risk for hemorrhage has evolved over time.
Interventions provided to injured patients during prehospital care, close to the time of injury, result in improved outcomes and survival. On the basis of extrapolation from hospital-based data, guidelines now recommend prehospital tranexamic acid administration.
TXA is said to benefit trauma patients with hemodynamic instability and noncompressible bleeding. It’s a relatively affordable intervention, and studies have shown it can reduce mortality.
The European guideline on management of major bleeding and coagulopathy trauma recommends early administration of TXA to prevent bleeding. However, the risks and benefits associated with tranexamic acid initiated in the prehospital environment, before trauma center evaluation, are unknown.
This study had an objective to evaluate “the efficacy and impact of TXA administration in the prehospital setting on reducing mortality, associated thromboembolic events, and blood transfusion in trauma patients.”
Tranexamic acid given to injured patients at risk for hemorrhage in the pre-hospital setting is safe and associated with survival benefit in specific subgroups of patients.
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Purpose
The purpose of this study was to test the efficacy of prehospital administration of tranexamic acid (TXA) to injured patients on mortality, thromboembolic events and need for blood transfusion in a level 1 trauma center.
Methods
We conducted a retrospective study comparing adult trauma patients receiving or not receiving prehospital TXA between January 2017 and September 2018. Patients not receiving TXA but transfused within 4 h of admission were 1:1 matched to TXA-treated patients for age, sex, injury severity score, head abbreviated injury score, prehospital heart rate and systolic blood pressure.
Results
In total 204 patients were included (102 TXA and 102 control), with a mean age of 31 years. On admission, shock index and serum lactate were greater in the control group, whereas the initial base deficit, hemoglobin levels and EMS time were comparable in both groups. The median amount of blood transfusion was greater in the control group [eight units (range 1–40) vs three (range 0–40), as well as the use of massive blood transfusion. In the TXA group, VTE was higher; whereas the overall mortality was lower without reaching statistical significance.
Conclusions
Prehospital TXA administration is associated with less in-hospital blood transfusion and massive transfusion protocol (MTP). There is no significant increase in the thromboembolic events and mortality, however, further evaluation in larger clinical trials is needed.
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