Development of a Prehospital Tranexamic Acid Administration Protocol

Strosberg, David S.; Nguyen, Michelle C.; Mostafavifar, Lisa; Mell, Howard K.; Evans, David C.

doi:10.3109/10903127.2015.1128033

Cited by 18 publications

(10 citation statements)

References 15 publications

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“…In our small study, we have shown that nurses working in an emergency centre setting can identify suitable patients and safely administer TXA to a similar level described in the prehospital literature [17] .…”

Section: Discussionmentioning

confidence: 61%

“…As the benefit of TXA is being increasingly recognised, strategies to deliver it to bleeding patients have been developed. The first step was inclusion into hospital major haemorrhage protocols, and as the importance of early administration became more apparent, prehospital usage has followed [17] , [18] , [19] . However, these strategies have all generally trickled down from high-income countries.…”

Section: Discussionmentioning

confidence: 99%

“…It was also added to the South African Medical Formulary and the Essential Medicines List in 2015 [15] as well as the 10th edition of the Advanced Trauma Life Support course in 2017 [16] . Recognition of the need for timely administration has led to inclusion in paramedic guidelines in the UK and USA [17] , [18] , [19] .…”

Section: Introductionmentioning

confidence: 99%

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Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa

Wearmouth

Smith²

2019

African Journal of Emergency Medicine

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Introduction Administration of tranexamic acid (TXA) has been shown to effectively reduce all-cause mortality in trauma patients when given within three hours of injury. We found that many trauma patients in our hospital were not receiving TXA. This was due to a variety of factors, including late presentation to hospital, lack of staff awareness, short staffing, and unavailable drugs or equipment. Our aim was to develop a protocol for safe, nurse-led administration of TXA in the emergency centre in order to increase the number of eligible patients treated. Methods We developed a protocol based on the inclusion criteria of the CRASH-2 study, opting to use physiological observations along with criteria from the South African Triage Scale to allow nursing staff to identify patients with, or at risk of, significant haemorrhage. We tailored the protocol to the equipment and training available in our poorly resourced rural healthcare setting. Results In a two-month period, 14 patients were given TXA by nurses before the arrival of a doctor. 13/14 (92.9%) were deemed appropriate, with 1/14 (7.1%) deemed inappropriate due to the time since injury. 12/13 (92.3%) patients received the correct infusion dose, with 1/13 (7.7%) only receiving the infusion once the doctor arrived. No adverse events were reported. Conclusions Nursing staff in resource poor rural settings can use a protocol based on the South African Triage Scale and the CRASH-2 study to safely administer TXA to trauma patients. We believe this to be the first published literature on nurse-led administration of TXA. Mortality from trauma may be reduced in rural settings by the timely administration of TXA in the prehospital and rural primary healthcare settings.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa

Wearmouth

Smith²

2019

African Journal of Emergency Medicine

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“…However, it was also reported that pharmacist intervention did not increase adherence to guideline‐directed statin therapy, and pharmacist intervention did not significantly affect prescribers' adherence rate to the 2013 American college of cardiology/American heart association cholesterol guideline . To the best of our knowledge, no pharmacist‐led intervention on TXA treatment has been reported, besides one pre‐hospital administration protocol where the pharmacist was responsible for expediting the delivery of TXA to the trauma bay …”

Section: Introductionmentioning

confidence: 94%

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Zhou

Bao

2019

Basic Clin Pharma Tox

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Background: Total knee arthroplasty (TKA) is associated with blood loss and an increased risk of transfusion. Guidelines for antifibrinolytic drug tranexamic acid (TXA) treatment in TKA patients are available. We evaluated the effects of anticoagulant pharmacist intervention on perioperative blood conservation treatment in TKA patients. Methods: In a retrospective, observational experimental study, patients admitted for TKA were allocated into the control or pharmacist intervention group. In the intervention phase, multiple interventions of TXA treatment based on guidelines were implemented. The primary endpoint was blood loss. Other outcome included postoperative haemoglobin and haematocrit levels, allogeneic blood transfusion, cost savings and safety. Results: A total of 177 patients were included (88 and 89 in the control and intervention group, respectively). In the intervention group, 24.72% orders of TXA dosage, 20.22% orders of drug choice, 26.97% orders of TXA timing and 30.34% orders of TXA administration manner were adjusted. Eighty-nine (100%) patients received blood conservation therapy compared with 21 (23.86%) patients in the control group (P < 0.001). Total blood loss was 1133.31 ± 627.08 mL in the control group compared with 604.34 ± 459.09 mL in the intervention group (P < 0.001). Postoperative drops in haemoglobin and haematocrit in the control group were greater than in the intervention group (P < 0.001). The rate of allogeneic blood transfusion was 40.91% in the control group compared with 21.35% in the intervention group (P = 0.01). Pharmacist intervention was conducted to cost savings resulting from reduced transfusion, but with comparable safety profile. Conclusions: Anticoagulant pharmacist intervention on blood conservation treatment of TKA patients leads to favourable clinical and economic outcome.allogeneic blood transfusion, blood conservation, pharmacist intervention, tranexamic acid, venous thromboembolism Abbreviations: BMI, body mass index; DVT, deep vein thrombosis; Hb, haemoglobin; Hct, haematocrit; TKA, total knee arthroplasty; TXA, tranexamic acid; VTE, venous thromboembolism.

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“…10,11 Nevertheless, the current European Trauma Treatment Guidelines recommend the early use of TXA in bleeding trauma patients. 12 In addition, up to now, only few retrospective studies on the prehospital use of TXA exist [13][14][15] and the exact mechanism of action of early TXA administration in trauma patients is insufficiently known.…”

mentioning

confidence: 99%

The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients

Stein

Studt

Albrecht

et al. 2018

Anesthesia &Amp; Analgesia

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Development of a Prehospital Tranexamic Acid Administration Protocol

Cited by 18 publications

References 15 publications

Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa

Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients

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