Compliance of tranexamic acid administration to trauma patients at a level-one trauma centre

Abstract

Compliance with TXA administration to trauma patients with suspected major bleeding was low. Quality improvement strategies aimed at increasing appropriate use of TXA are warranted.

Assessing the clinical utilization of tranexamic acid by paramedics for patients with major trauma (ACUTE)

“…This rate is higher than others cited in previous studies. A centre in BC found a pre-hospital administration rate of 19% for their patients, while another centre in Ontario had an intra-hospital administration rate of 27% [8,9]. There is still potential to further increase administration rates, but some factors may limit the ability to give TXA such as poor intravenous accessibility, time constraints from heavy workloads, or short trips to the hospital.…”

Trauma systems and emergency medical services: The missing link for tranexamic acid utilization in major trauma

“…6 In the context of trauma acute care, I will specifically focus this editorial on the paper by Ghawnni et al on the evaluation of the utilization of life-saving tranexamic acid (TXA) in a tertiary trauma centre. 7 In this observational study, the authors from the trauma program at Hamilton Health Sciences Centre and McMaster University bravely report on a retrospective evaluation of a cohort of major trauma patients and compliance with TXA administration. Their inclusion criteria are those parameters defined in the CRASH-2 trial for the administration of TXA, 8 combined with those inclusion criteria used in the MATTERS trial, 9 an observational study that demonstrated a mortality benefit in major trauma patients receiving TXA.…”

“…10 The authors note that hemorrhage resulting from vascular disruption remains the leading cause of preventable death in civilian trauma. 3,7 They also note that the CRASH-2 trial recommends the use of TXA within 3 hours of injury. 8 They excluded from their analysis those patients who received TXA at other sending sites (21 of 534 patients), and their final cohort for analysis, after excluding patients with missing data, was 495 patients over a 2-year period.…”

“…9 patient's hospital arrival time in the group (27.1%, n = 134) who actually received TXA. 7 However, no effort was made to determine and report the total actual time from injury to drug administration. They assume that their time of 47 minutes represents a good, CRASH-2 compliant metric because this surrogate measurement is within 3 hours of injury.…”

Does Tranexamic Acid Cause Venous Thromboembolism After Trauma?

“…Despite the widespread incorporation of TXA into massive transfusion protocols, variance remains in the use of TXA between trauma centers . Recent data suggest there is significant overall underuse of TXA . Johnston et al describe a single referral center’s retrospective observation of possible overuse and offer data to support a major paradigm shift, pushing for less overall TXA use.…”