Efficacy of prehospital administration of tranexamic acid in trauma patients: A meta-analysis of the randomized controlled trials

El‐Menyar, Ayman; Sathian, Brijesh; Asim, Mohammad; Latifi, Rifat; Al-Thani, Hassan

doi:10.1016/j.ajem.2018.03.033

Cited by 32 publications

(20 citation statements)

References 33 publications

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“…El-Menyar et al looked at the efficacy of pre-hospital TXA in a meta-analysis and showed that it reduced 24-h and 30-day mortality and thromboembolic events. However, the authors found only two studies and concluded that further RCTs are required [503]. This is in keeping with a recent study demonstrating the benefit of on-scene administration of TXA in patients with major trauma.…”

Section: Resultssupporting

confidence: 52%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultssupporting

confidence: 52%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…Moreover, these guidelines are being reviewed annually and updated with any significant changes recommended as per the International Clinical Practice. This approach facilitates rapid adoption of the best clinical practice which is evident from the recent introduction of prehospital tranexamic acid administration based on the CRASH-2 study recommendations[9] and the use of a standardized prehospital Rapid Sequence Induction protocol[10] as the standard of care.…”

Section: Prehospital Carementioning

confidence: 99%

Evolution of the Qatar trauma system: The journey from inception to verification

Al-Thani

El‐Menyar

Asim

et al. 2019

J Emerg Trauma Shock

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Traumatic injuries accounted for substantial burden of morbidity and mortality (M and M) worldwide. Despite better socioeconomic conditions and living standards, the incidence of trauma is rising in the Eastern Mediterranean Region (EMR). Road traffic injuries are the leading cause of the high fatality rate in young economically productive adults in our region. The provision of trauma care at high-volume, accredited trauma center by a team of dedicated full-time professional health-care providers has been shown to improve the quality of care and the outcomes for trauma victims. With persistent hard work and effective leadership, in Qatar, the Trauma Section has evolved into a well-reputed and internationally recognized Center of Excellence in Trauma Care, Hamad Level 1 Trauma Center. In 2014, Qatar Trauma System was accredited with Trauma Distinction Award by the Accreditation Canada International, for high-quality trauma care of severely injured patients; first in the Middle East. The Hamad Trauma Center is committed to the advancement of trauma care in different aspects right from the immediate prehospital care to the subsequent hospital-based care, involving diagnosis, treatment, support, rehabilitation, and community reintegration of the patients and injury prevention. Our trauma system has gradually embedded with a structured and matured research unit with dedicated clinicians and academic researchers. The trauma team embodies the 21st-century paradigm of translational research and injury prevention by going well beyond the bedside, out into the populations that need it most. The trauma system's future vision relies on the evidence-based health-care service and better outcomes; state-of-the-art infrastructure and multidimensional collaborations with health care and governmental services to minimize the burden of M and M caused by traumatic injury in the State of Qatar and to fulfill the population health enhancement strategy.

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“…Literature data also suggest early use of TXA in various clinical settings to reduce blood loss irrespective of the type of surgery and bleeding volume for providing a survival advantage to many patients [105]. A meta-analysis of the randomized controlled trials for the efficacy of prehospital administration of TXA in trauma patients showed a trend toward lower 30-day mortality and a reduced risk of thromboembolic events [41].…”

Section: Tranexamic Acidmentioning

confidence: 99%

Hemostatic agents for prehospital hemorrhage control: a narrative review

Peng

2020

Military Med Res

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Hemorrhage is the leading cause of preventable death in combat trauma and the secondary cause of death in civilian trauma. A significant number of deaths due to hemorrhage occur before and in the first hour after hospital arrival. A literature search was performed through PubMed, Scopus, and Institute of Scientific Information databases for English language articles using terms relating to hemostatic agents, prehospital, battlefield or combat dressings, and prehospital hemostatic resuscitation, followed by cross-reference searching. Abstracts were screened to determine relevance and whether appropriate further review of the original articles was warranted. Based on these findings, this paper provides a review of a variety of hemostatic agents ranging from clinically approved products for human use to newly developed concepts with great potential for use in prehospital settings. These hemostatic agents can be administered either systemically or locally to stop bleeding through different mechanisms of action. Comparisons of current hemostatic products and further directions for prehospital hemorrhage control are also discussed.

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Efficacy of prehospital administration of tranexamic acid in trauma patients: A meta-analysis of the randomized controlled trials

Cited by 32 publications

References 33 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Evolution of the Qatar trauma system: The journey from inception to verification

Hemostatic agents for prehospital hemorrhage control: a narrative review

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