Do all trauma patients benefit from tranexamic acid?

Evan J. Valle, Casey J. Allen, Robert M. Van Haren, Jassin M. Jouria, Hua Li, Alan Livingstone, Nicholas Namias, Carl I Schulman, Kenneth G Proctor

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: This study tested the hypothesis that early routine use of tranexamic acid (TXA) reduces mortality in a subset of the most critically injured trauma intensive care unit patients. Methods: Consecutive trauma patients (n = 1,217) who required emergency surgery (OR) and/or transfusions from August 2009 to January 2013 were reviewed. At surgeon discretion, TXA was administered at a median of 97 minutes (1-g bolus then 1-g over 8 hours) to 150 patients deemed high risk for hemorrhagic death. With the use of propensity scores based on age, sex, traumatic brain injury (TBI), mechanism of injury, systolic blood pressure, transfusion requirements, and Injury Severity Score (ISS), these patients were matched to 150 non-TXA patients. Results: The study population was 43 years old, 86% male, 54% penetrating mechanism of injury, 25% TBI, 28 ISS, with 22% mortality. OR was required in 78% at 86 minutes, transfusion was required in 97% at 36 minutes, and 75% received both. For TXA versus no TXA, more packed red blood cells and total fluid were required, and mortality was 27% versus 17% (all p < 0.05). The effects of TXA were similar in those with or without TBI, although ISS, fluid, and mortality were all higher in the TBI group. Mortality associated with TXA was influenced by the timing of administration (p < 0.05), but any benefit was eliminated in those who required more than 2,000-mL packed red blood cells, who presented with systolic blood pressure of less than 120 mm Hg or who required OR (all p < 0.05). Conclusion: For the highest injury acuity patients, TXA was associated with increased, rather than reduced, mortality, no matter what time it was administered. This lack of benefit can probably be attributed to the rapid availability of fluids and emergency OR at this trauma center. Prospective studies are needed to further identify conditions that may override the benefits from TXA. Level of Evidence: Therapeutic study, level IV.

Original languageEnglish
Pages (from-to)1373-1378
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number6
DOIs
StatePublished - Jan 1 2014

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Tranexamic Acid
Wounds and Injuries
Injury Severity Score
Mortality
Blood Pressure
Emergencies
Erythrocytes
Patient Acuity
Propensity Score
Trauma Centers
Blood Transfusion
Intensive Care Units
Prospective Studies
Acids
Traumatic Brain Injury

Keywords

  • Hemostasis
  • resuscitation
  • transfusion

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Do all trauma patients benefit from tranexamic acid? / Valle, Evan J.; Allen, Casey J.; Van Haren, Robert M.; Jouria, Jassin M.; Li, Hua; Livingstone, Alan; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 6, 01.01.2014, p. 1373-1378.

Research output: Contribution to journalArticle

Valle, Evan J. ; Allen, Casey J. ; Van Haren, Robert M. ; Jouria, Jassin M. ; Li, Hua ; Livingstone, Alan ; Namias, Nicholas ; Schulman, Carl I ; Proctor, Kenneth G. / Do all trauma patients benefit from tranexamic acid?. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 6. pp. 1373-1378.
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AU - Allen, Casey J.

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AU - Jouria, Jassin M.

AU - Li, Hua

AU - Livingstone, Alan

AU - Namias, Nicholas

AU - Schulman, Carl I

AU - Proctor, Kenneth G

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N2 - Background: This study tested the hypothesis that early routine use of tranexamic acid (TXA) reduces mortality in a subset of the most critically injured trauma intensive care unit patients. Methods: Consecutive trauma patients (n = 1,217) who required emergency surgery (OR) and/or transfusions from August 2009 to January 2013 were reviewed. At surgeon discretion, TXA was administered at a median of 97 minutes (1-g bolus then 1-g over 8 hours) to 150 patients deemed high risk for hemorrhagic death. With the use of propensity scores based on age, sex, traumatic brain injury (TBI), mechanism of injury, systolic blood pressure, transfusion requirements, and Injury Severity Score (ISS), these patients were matched to 150 non-TXA patients. Results: The study population was 43 years old, 86% male, 54% penetrating mechanism of injury, 25% TBI, 28 ISS, with 22% mortality. OR was required in 78% at 86 minutes, transfusion was required in 97% at 36 minutes, and 75% received both. For TXA versus no TXA, more packed red blood cells and total fluid were required, and mortality was 27% versus 17% (all p < 0.05). The effects of TXA were similar in those with or without TBI, although ISS, fluid, and mortality were all higher in the TBI group. Mortality associated with TXA was influenced by the timing of administration (p < 0.05), but any benefit was eliminated in those who required more than 2,000-mL packed red blood cells, who presented with systolic blood pressure of less than 120 mm Hg or who required OR (all p < 0.05). Conclusion: For the highest injury acuity patients, TXA was associated with increased, rather than reduced, mortality, no matter what time it was administered. This lack of benefit can probably be attributed to the rapid availability of fluids and emergency OR at this trauma center. Prospective studies are needed to further identify conditions that may override the benefits from TXA. Level of Evidence: Therapeutic study, level IV.

AB - Background: This study tested the hypothesis that early routine use of tranexamic acid (TXA) reduces mortality in a subset of the most critically injured trauma intensive care unit patients. Methods: Consecutive trauma patients (n = 1,217) who required emergency surgery (OR) and/or transfusions from August 2009 to January 2013 were reviewed. At surgeon discretion, TXA was administered at a median of 97 minutes (1-g bolus then 1-g over 8 hours) to 150 patients deemed high risk for hemorrhagic death. With the use of propensity scores based on age, sex, traumatic brain injury (TBI), mechanism of injury, systolic blood pressure, transfusion requirements, and Injury Severity Score (ISS), these patients were matched to 150 non-TXA patients. Results: The study population was 43 years old, 86% male, 54% penetrating mechanism of injury, 25% TBI, 28 ISS, with 22% mortality. OR was required in 78% at 86 minutes, transfusion was required in 97% at 36 minutes, and 75% received both. For TXA versus no TXA, more packed red blood cells and total fluid were required, and mortality was 27% versus 17% (all p < 0.05). The effects of TXA were similar in those with or without TBI, although ISS, fluid, and mortality were all higher in the TBI group. Mortality associated with TXA was influenced by the timing of administration (p < 0.05), but any benefit was eliminated in those who required more than 2,000-mL packed red blood cells, who presented with systolic blood pressure of less than 120 mm Hg or who required OR (all p < 0.05). Conclusion: For the highest injury acuity patients, TXA was associated with increased, rather than reduced, mortality, no matter what time it was administered. This lack of benefit can probably be attributed to the rapid availability of fluids and emergency OR at this trauma center. Prospective studies are needed to further identify conditions that may override the benefits from TXA. Level of Evidence: Therapeutic study, level IV.

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KW - resuscitation

KW - transfusion

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