The impact of prehospital TXA on mortality among bleeding trauma patients: A systematic review and meta-analysis

Almuwallad, Ateeq; Cole, Elaine; Ross, Jane; Perkins, Zane; Davenport, Ross

doi:10.1097/ta.0000000000003120

Cited by 28 publications

(16 citation statements)

References 34 publications

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“…Early in-hospital mortality (after 6 h und 12 h) was significantly lower in the TXA group with a respective trend for the first 24 h after admission [ 34 ]. Death due to trauma associated hemorrhage was significantly less common.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The evidence of benefit to early administration of TXA has led to the growing implementation of prehospital TXA to injured patients at risk of bleeding [1,7,12,13,18,[46][47][48][49][50][51][52]. An earlier retrospective study from our center demonstrated that prehospital TXA administration was associated with a lesser need of in-hospital blood transfusion and MTP activation [35].…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic injuries represent 10% of the disease burden worldwide and particularly trauma-induced hemorrhage which is the most preventable cause of mortality among injured patients [1][2][3][4]. Around one-fourth of trauma patients are susceptible to develop acute coagulopathy and those with uncontrolled hemorrhage are at increased risk of hemorrhagic shock and mortality [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

El‐Menyar

Ahmed

Hakim

et al. 2021

Eur J Trauma Emerg Surg

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Background Prehospital administration of tranexamic acid (TXA) to injured patients is increasing worldwide. However, optimal TXA dose and need of a second infusion on hospital arrival remain undetermined. We investigated the efficacy and safety of the second in-hospital dose of TXA in injured patients receiving 1 g of TXA in the prehospital setting. We hypothesized that a second in-hospital dose of TXA improves survival of trauma patients. Methods A prospective, double-blind, placebo-controlled randomized, clinical trial included adult trauma patients receiving 1 g of TXA in the prehospital settings. Patients were then blindly randomized to Group I (second 1-g TXA) and Group II (placebo) on hospital arrival. The primary outcome was 24-h (early) and 28-day (late) mortality. Secondary outcomes were thromboembolic events, blood transfusions, hospital length of stay (HLOS) and organs failure (MOF). Results A total of 220 patients were enrolled, 110 in each group. The TXA and placebo groups had a similar early [OR 1.000 (0.062–16.192); p = 0.47] and late mortality [OR 0.476 (95% CI 0.157–1.442), p = 0.18].The cause of death (n = 15) was traumatic brain injury (TBI) in 12 patients and MOF in 3 patients. The need for blood transfusions in the first 24 h, number of transfused blood units, HLOS, thromboembolic events and multiorgan failure were comparable in the TXA and placebo groups. In seriously injured patients (injury severity score > 24), the MTP activation was higher in the placebo group (31.3% vs 11.10%, p = 0.13), whereas pulmonary embolism (6.9% vs 2.9%, p = 0.44) and late mortality (27.6% vs 14.3%, p = 0.17) were higher in the TXA group but did not reach statistical significance. Conclusion The second TXA dose did not change the mortality rate, need for blood transfusion, thromboembolic complications, organ failure and HLOS compared to a single prehospital dose and thus its routine administration should be revisited in larger and multicenter studies. Trial registration ClinicalTrials.gov Identifier: NCT03846973.

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“…neurosurgery, though it is a safe and effective means to reduce operative blood loss and blood transfusion rates in cardiac, pulmonary, trauma, obstetric, spinal and orthopaedic surgery. [11][12][13][14] As a synthetic lysine analogue, TXA can modify brain network excitability by activating excitatory ionotropic glutamate receptors. 15 16 On the other hand, TXA may induce hyperexcitability by blocking gamma-aminobutyric acid-driven inhibition of the central nervous system.…”

Section: Open Accessmentioning

confidence: 99%

“…TXA is used as a bolus ranging from 10 to 50 mg/kg, followed by a continuous infusion ranging from 1 to 5 mg/kg/hour until the end of the procedures in a variety of neurosurgical procedures 3 8–10. Unfortunately, the risk of postoperative seizures remains uncertain, and restricts the routine use of TXA in neurosurgery, though it is a safe and effective means to reduce operative blood loss and blood transfusion rates in cardiac, pulmonary, trauma, obstetric, spinal and orthopaedic surgery 11–14…”

Section: Introductionmentioning

confidence: 99%

Safety of intravenous tranexamic acid in patients undergoing supratentorial meningiomas resection: protocol for a randomised, parallel-group, placebo control, non-inferiority trial

Yan

et al. 2022

BMJ Open

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IntroductionGrowing evidence recommends antifibrinolytic agent tranexamic acid (TXA) to reduce blood loss and transfusions rate in various surgical settings. However, postoperative seizure, as one of the major adverse effects of TXA infusion, has been a concern that restricts its utility in neurosurgery.Methods and analysisThis is a randomised, placebo-controlled, non-inferiority trial. Patients with supratentorial meningiomas and deemed suitable for surgical resection will be recruited in the trial. Patients will be randomised to receive either a single administration of 20 mg/kg TXA or a placebo of the same volume with a 1:1 allocation ratio after anaesthesia induction. The primary endpoint is the cumulative incidence of early postoperative seizures within 7 days after craniotomy. Secondary outcomes include the incidence of non-seizure complications, changes of haemoglobin level from baseline, intraoperative blood loss, erythrocyte transfusion volume, Karnofsky Performance Status, all-cause mortality, and length of stay, and total hospitalisation cost.Ethics and disseminationThis trial is registered at ClinicalTrial.gov and approved by the Chinese Ethics Committee of Registering Clinical Trials (ChiECRCT20200224). The findings will be disseminated in peer-reviewed journals and presented at national or international conferences relevant to subject fields.Trial registration numberNCT04595786.

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The impact of prehospital TXA on mortality among bleeding trauma patients: A systematic review and meta-analysis

Cited by 28 publications

References 34 publications

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

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

Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

Safety of intravenous tranexamic acid in patients undergoing supratentorial meningiomas resection: protocol for a randomised, parallel-group, placebo control, non-inferiority trial

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