Abstract
Introduction
Tranexamic acid (TXA) has been shown to decrease mortality in adult trauma patients
with or at significant risk of hemorrhage when administered within 3 h of injury.
The use and appropriateness of TXA in adult trauma patients presenting to Royal Columbian
Hospital (RCH) was investigated.
Methods
This retrospective chart review utilized the British Columbia Trauma Registry to identify
100 consecutive trauma patients that presented to the emergency department at RCH
between April 2012 to June 2015 and met the following indications for TXA: systolic
blood pressure <90 mm Hg and/or heart rate >110 bpm and presentation within 8 h of
injury. Primary outcomes included: percentage that met indications for TXA, received
TXA according to the CRASH-2 protocol, received a pre-hospital dose, and received TXA ≤1, >1 to ≤3, or >3 h from
injury.
Results
During the given time period, 117 subjects (2.7%) met indications for TXA. 67 patients
(57%) received TXA in any dose, with 10 subjects (8.5%) receiving TXA according to
the CRASH-2 protocol. Of the 67 patients who received any TXA, 76% did so ≤3 h. 22 patients (19%)
received TXA as a pre-hospital dose.
Conclusions
<10% of adult trauma patients that met the indication for TXA received it according
to the CRASH-2 protocol. Of those patients that received TXA, 76% did so within 3 h. Further inquiry
to identify reasons trauma patients are not receiving TXA as well as quality improvement
initiatives in trauma care are required.
Level of evidence
III
Study type
Therapeutic
Keywords
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References
WHO, Injuries and violence: the facts [Internet]. WHO. [cited 2017 Oct 9]. Available from: http://www.who.int/violence_injury_prevention/key_facts/en/
- Years of Potential Life Lost (YPLL) 1981–2015 [Internet]. National Center for Injury Prevention and Control, 2017 (Available from:)
- Epidemiology of traumatic deaths: comprehensive population-based assessment.World J Surg. 2010 Jan; 34: 158-163
- Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis.J Trauma. 2008 May; 64 (discussion 1217): 1211-1217
- The coagulopathy of trauma: a review of mechanisms.J Trauma. 2008 Oct; 65: 748-754
- Acute coagulopathy of trauma: mechanism, identification and effect.Curr Opin Crit Care. 2007 Dec; 13: 680-685
- Tranexamic acid: a review of its use in surgery and other indications.Drugs. 1999 Jun; 57: 1005-1032
- 19th WHO model list of essential medicines [Internet].([cited 2015 Jul 2]. Available from:)
- Tranexamic acid—an old drug still going strong and making a revival.Thromb Res. 2015 Feb; 135: 231-242
- Lexi-drugs [Internet]. Lexicomp online.([cited 2018 May 28]. Available from:)
- Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.Lancet Lond Engl. 2010 Jul 3; 376: 23-32
- The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial.Lancet Lond Engl. 2011 Mar 26; 377 (1101.e1–2): 1096-1101
- Major trauma and the injury severity score — where should we set the bar?.Annu Proc Assoc Adv Automot Med. 2007; 51: 13-29
- Tranexamic acid for trauma.Lancet Lond Engl. 2011 Mar 26; 377: 1052-1054
- Tranexamic acid for trauma resuscitation in the United States of America.Semin Thromb Hemost. 2017 Mar; 43: 213-223
- PATCH-trauma study investigators. Tranexamic acid for trauma: filling the “GAP” in evidence.Emerg Med Australas EMA. 2014 Apr; 26: 194-197
- Design of the Study of Tranexamic Acid during Air Medical Prehospital Transport (STAAMP) trial: addressing the knowledge gaps.Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2015 Mar; 19: 79-86
- Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study.Arch Surg Chic Ill 1960. 2012 Feb; 147: 113-119
- Prehospital use of tranexamic acid for hemorrhagic shock in primary and secondary air medical evacuation.Air Med J. 2013 Oct; 32: 289-292
- Tranexamic acid as part of remote damage-control resuscitation in the prehospital setting: a critical appraisal of the medical literature and available alternatives.J Trauma Acute Care Surg. 2015 Jun; 78: S70-S75
- Addition of tranexamic acid to a traumatic injury massive transfusion protocol.Am J Health-Syst Pharm AJHP Off J Am Soc Health-Syst Pharm. 2015 Jun 15; 72: 1059-1064
- Association of cryoprecipitate and tranexamic acid with improved survival following wartime injury: findings from the MATTERs II study.JAMA Surg. 2013 Mar; 148: 218-225
- Tranexamic acid.in: Martindale: the complete drug reference [Internet]. Online. The Pharmaceutical Press, 2013 ([cited 2015 Jul 2]. Available from:)
Article Info
Publication History
Published online: June 05, 2018
Accepted:
June 5,
2018
Received in revised form:
May 30,
2018
Received:
April 5,
2018
Footnotes
☆Authors would like to acknowledge Flora Young, Kathleen Fyvie, Joe Haegert and Iain MacPhail for their assistance during the course of this study. Authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. JP and SB proposed the study. MN collected data and drafted the manuscript. All authors were involved in study design, data interpretation, and critical revision.
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