Prehospital Use of Tranexamic Acid for Hemorrhagic Shock in Primary and Secondary Air Medical Evacuation

Vu, Erik; Schlamp, R; Wand, Robert; Kleine-Deters, Geoff A.; Vu, Mark; Tallon, John M.

doi:10.1016/j.amj.2013.05.001

Cited by 46 publications

(33 citation statements)

References 21 publications

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“…Thus, the need for studies separating these two groups (penetrating vs. blunt trauma patients) is more important for epidemiological purposes than for driving clinical practice. There is evidence of the safety of the use of tranexamic acid in the prehospital setting (level of evidence C) 11 , 26 . The authors of this study believe that, since that there is enough evidence that the sooner TXA is used, the greater the benefit it provides, additional studies comparing the effectiveness of the drug administered in the prehospital environment with its use inside the hospital are not necessary 5 , 24 .…”

Section: Resultsmentioning

confidence: 91%

“…As the mean time to response was reported as 33 min, it is concluded that TXA was administered on average 65 min after injury. The authors did not report any adverse effects related to intervention 26 .…”

Section: Resultsmentioning

confidence: 99%

“…A recent study in the prehospital care with medical evacuation by helicopter was published in 2013 26 . Inclusion criteria for this study were: patients older than 16 years of age, heart rate of more than 110 beats per minute and systolic blood pressure of less than 90 mmHg (very similar criteria to the ones from CRASH-2 study) 5 , 26 .…”

Section: Resultsmentioning

confidence: 99%

“…Inclusion criteria for this study were: patients older than 16 years of age, heart rate of more than 110 beats per minute and systolic blood pressure of less than 90 mmHg (very similar criteria to the ones from CRASH-2 study) 5 , 26 . The intervention included TXA administration to all patients during transport, associated to treatment with permissive hypotension in those with injuries in the chest and abdomen.…”

Section: Resultsmentioning

confidence: 99%

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Use of Tranexamic Acid in Trauma Patients: An Analysis of Cost-Effectiveness for Use in Brazil

PINTO¹,

SILVA²,

Chedid³

et al. 2016

ABCD, arq. bras. cir. dig.

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Introduction: Use of tranexamic acid (TXA) in trauma has been the subject of growing interest by researchers and health professionals. However, there are still several open questions regarding its use. In some aspects medical literature is controversial. The points of disagreement among experts include questions such as: Which patients should receive TXA in trauma? Should treatment be performed in the pre-hospital environment? Is there any need for laboratory parameters before starting TXA treatment? What is the drug safety profile? The main issue on which there is still no basis in literature is: What is the indication for treatment within massive transfusion protocols? Objective: Answer the questions proposed based on critical evaluation of the evidence gathered so far and carry out a study of cost-effectiveness of TXA use in trauma adapted to the Brazilian reality. Methods: A literature review was performed through searching Pubmed.com, Embase and Cab Abstract by headings "tranexamic AND trauma", in all languages, yielding 426 articles. Manuscripts reporting on TXA utilization for elective procedures were excluded, remaining 79 articles. Fifty-five articles were selected, and critically evaluated in order to answer study questions. The evaluation of cost effectiveness was performed using CRASH-2 trial data and Brazilian official population data. Results: TXA is effective and efficient, and should be administered to a wide range of patients, including those with indication evaluated in research protocols and current indication criteria for TXA should be expanded. As for the cost-effectiveness, the TXA proved to be cost-effective with an average cost of R$ 61.35 (currently US$16) per year of life saved. Conclusion: The use of TXA in trauma setting seems to be effective, efficient and cost-effective in the various groups of polytrauma patients. Its use in massive transfusion protocols should be the subject of further investigations.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Use of Tranexamic Acid in Trauma Patients: An Analysis of Cost-Effectiveness for Use in Brazil

PINTO¹,

SILVA²,

Chedid³

et al. 2016

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

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“…Two small studies have demonstrated the feasibility of TXA administration in the prehospital setting 16,17. However, both studies were based on a smaller sample size of 40 and 13 patients, which limited the generalizability of their findings 16,17.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study

Dong

et al. 2017

WestJEM

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IntroductionThe California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess the safety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-induced hemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administration by paramedics within the framework of North American emergency medicine standards and protocols.MethodsThis is an ongoing multi-centered, prospective, observational cohort study with a retrospective chart-review comparison. Trauma patients identified in the prehospital setting with signs of hemorrhagic shock by first responders were administered one gram of TXA followed by an optional second one-gram dose upon arrival to the hospital, if the patient still met inclusion criteria. Patients administered TXA make up the prehospital intervention group. Control group patients met the same inclusion criteria as TXA candidates and were matched with the prehospital intervention patients based on mechanism of injury, injury severity score, and age. The primary outcomes were mortality, measured at 24 hours, 48 hours, and 28 days. Secondary outcomes measured included the total blood products transfused and any known adverse events associated with TXA administration.ResultsWe included 128 patients in the prehospital intervention group and 125 in the control group. Although not statistically significant, the prehospital intervention group trended toward a lower 24-hour mortality rate (3.9% vs 7.2% for intervention and control, respectively, p=0.25), 48-hour mortality rate (6.3% vs 7.2% for intervention and control, respectively, p=0.76), and 28-day mortality rate (6.3% vs 10.4% for intervention and control, respectively, p=0.23). There was no significant difference observed in known adverse events associated with TXA administration in the prehospital intervention group and control group. A reduction in total blood product usage was observed following the administration of TXA (control: 6.95 units; intervention: 4.09 units; p=0.01).ConclusionPreliminary evidence from the Cal-PAT study suggests that TXA administration may be safe in the prehospital setting with no significant change in adverse events observed and an associated decreased use of blood products in cases of trauma-induced hemorrhagic shock. Given the current sample size, a statistically significant decrease in mortality was not observed. Additionally, this study demonstrates that it may be feasible for paramedics to identify and safely administer TXA in the prehospital setting.

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Anti-fibrinolytics

Draxler¹,

Medcalf²,

Gruen³

2020

Trauma Induced Coagulopathy

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Prehospital Use of Tranexamic Acid for Hemorrhagic Shock in Primary and Secondary Air Medical Evacuation

Cited by 46 publications

References 21 publications

Use of Tranexamic Acid in Trauma Patients: An Analysis of Cost-Effectiveness for Use in Brazil

Use of Tranexamic Acid in Trauma Patients: An Analysis of Cost-Effectiveness for Use in Brazil

Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study

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