The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®.

Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE

Publication: London, UK : BioMed Central Ltd
Original Publication: London : Current Science Ltd, c1997-

Blood Transfusion/*statistics & numerical data ; Emergency Medical Services/*standards ; Mortality/*trends ; Tranexamic Acid/*administration & dosage; Adult ; Aged ; Cohort Studies ; Emergency Medical Services/methods ; Emergency Medical Services/statistics & numerical data ; Female ; Germany ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Prospective Studies ; Registries/statistics & numerical data ; Tranexamic Acid/therapeutic use

Background: Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany.
Methods: The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included.
Results: The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080).
Conclusion: This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.
(© 2021. The Author(s).)

Comment in: Crit Care. 2021 Nov 1;25(1):379. (PMID: 34724963)

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Keywords: Bleeding; Coagulopathy; Hemostatic disorders; Mass transfusion; TXA; Tranexamic acid; Trauma; Trauma care

6T84R30KC1 (Tranexamic Acid)

Date Created: 20210805 Date Completed: 20211019 Latest Revision: 20211220

20221213

PMC8336395

10.1186/s13054-021-03701-7

34348782