Abstract
Objective
Antifibrinolytic agent tranexamic acid (TXA) has a potential clinical benefit for
in-hospital patients with severe bleeding but its effectiveness in pre-hospital settings
remains unclear. We conducted a systematic review and meta-analysis to evaluate whether
pre-hospital administration of TXA compared to placebo improve patients' outcomes?
Methods
PubMed, MEDLINE, Cochrane Library, WHO International Clinical Trials Registry Platform,
Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, clinicaltrials.gov and Google scholar databases were searched for a retrospective, prospective and randomized
(RCT) or quasi-RCT studies that assessed the effect of prehospital administration
of TXA versus placebo on the outcomes of trauma patients with significant hemorrhage.
The main outcomes of interest were 24 hour 30-day mortality and in-hospital thromboembolic complications. Two authors independently
abstracted the data using a data collection form. Results from different studies were
pooled for the analysis, when appropriate.
Results
Out of 92 references identified through the search, two analytical studies met the
inclusion criteria. The effect of TXA on 24-hour mortality had a pooled odds ratio
(OR) of 0.49 (95% CI 0.28–0.85), 30-day mortality OR of 0.86 (95% CI, 0.56–1.32),
and thromboembolic events OR of 0.74 (95% CI, 0.27–2.07).
Conclusion
Prehospital TXA appears to reduce early mortality in trauma patients. The pooled analysis
also shows a trend toward lower 30-day mortality and reduced risk of thromboembolic
events. Additional randomized controlled clinical trials are needed to determine the
significance of these trends.
Keywords
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Article Info
Publication History
Published online: March 16, 2018
Accepted:
March 14,
2018
Received in revised form:
March 14,
2018
Received:
January 16,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.