Empleo de ácido tranexámico en el herido de combate, experiencia de la sanidad militar española. Serie de casos y revisión de la literatura

Aedo-Martín, Daniel; Cañas, R. García; Suay, R. Navarro; Martínez-Roldán, M.; Baños-Turza, R.; Tamburri-Bariain, R

doi:10.1016/j.recot.2015.12.001

Cited by 3 publications

(5 citation statements)

References 30 publications

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“…Six studies were conducted in military hospitals16–21 and 14 were conducted in civilian hospitals (one study included both military and civilian hospitals) 21–34. One study administered TXA in the prehospital setting 29.…”

Section: Resultsmentioning

confidence: 99%

“…One study administered TXA in the prehospital setting 29. There were 13 retrospective studies,16–21,23–25,27,30,31,33 five prospective observational studies,22,26,28,29,32 and one randomized controlled trial 34. Ten studies22–26,29–32,34 reported administering TXA as given in the CRASH-2 trial (1 gram [g] intravenous [IV] bolus followed by 1 g IV over eight hours); three studies16,20,21 reported giving TXA 1 g bolus (without the maintenance dose), and six studies17–19,27,28,33 did not report TXA dosing.…”

Section: Resultsmentioning

confidence: 99%

“…There were 13 retrospective studies,16–21,23–25,27,30,31,33 five prospective observational studies,22,26,28,29,32 and one randomized controlled trial 34. Ten studies22–26,29–32,34 reported administering TXA as given in the CRASH-2 trial (1 gram [g] intravenous [IV] bolus followed by 1 g IV over eight hours); three studies16,20,21 reported giving TXA 1 g bolus (without the maintenance dose), and six studies17–19,27,28,33 did not report TXA dosing. Three studies17,27,34 administered TXA within eight hours from the time of injury (as done in the CRASH-2 trial), 12 studies16,18,21–26,29–32 administered TXA primarily within three hours from the time of injury, and four studies19,20,28,33 did not report the timing of TXA administration.…”

Section: Resultsmentioning

confidence: 99%

“…We did not include six studies in the meta-analyses due to significant clinical heterogeneity compared to the other studies. Reasons for exclusion of these studies were as follows: only included patients with injury by firearm or explosive;16 only included patients with hyperfibrinolysis;24 only included combat patients who survived 24 hours after injury27 or survived to receive treatment at a U.S. military hospital after transport from a combat hospital;18,19 or only included patients with traumatic brain injury 34…”

Section: Resultsmentioning

confidence: 99%

“…The greatest benefit occurs when TXA is given within <1 hour from injury, diminished benefit if given within one to three hours from injury, and no benefit if given after three hours from injury 6. In contrast to the CRASH-2 trial, three studies primarily administered only a bolus dose of TXA as opposed to a bolus dose with a subsequent maintenance dose 16,20,21. This may contribute to different thrombosis and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

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Mortality and Thrombosis in Injured Adults Receiving Tranexamic Acid in the Post-CRASH-2 Era

Benipal

Santamarina

et al. 2019

WestJEM

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Introduction The CRASH-2 trial demonstrated that tranexamic acid (TXA) reduced mortality with no increase in adverse events in severely injured adults. TXA has since been widely used in injured adults worldwide. Our objective was to estimate mortality and adverse events in adults with trauma receiving TXA in studies published after the CRASH-2 trial. Methods We systematically searched PubMed, Embase, MicroMedex, and ClinicalTrials.gov for studies that included injured adults who received TXA and reported mortality and/or adverse events. Two reviewers independently assessed study eligibility, abstracted data, and assessed the risk of bias. We conducted meta-analyses using random effects models to estimate the incidence of mortality at 28 or 30 days and in-hospital thrombotic events. Results We included 19 studies and 13 studies in the systematic review and meta-analyses, respectively. The pooled incidence of mortality at 28 or 30 days (five studies, 1538 patients) was 10.1% (95% confidence interval [CI], 7.8–12.4%) (vs 14.5% [95% CI, 13.9–15.2%] in the CRASH-2 trial), and the pooled incidence of in-hospital thrombotic events (nine studies, 1656 patients) was 5.9% (95% CI, 3.3–8.5%) (vs 2.0% [95% CI, 1.8–2.3%] in the CRASH-2 trial). Conclusion Compared to the CRASH-2 trial, adult trauma patients receiving TXA identified in our systematic review had a lower incidence of mortality at 28 or 30 days, but a higher incidence of in-hospital thrombotic events. Our findings neither support nor refute the findings of the CRASH-2 trial but suggest that incidence rates in adults with trauma in settings outside of the CRASH-2 trial may be different than those observed in the CRASH-2 trial.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Mortality and Thrombosis in Injured Adults Receiving Tranexamic Acid in the Post-CRASH-2 Era

Benipal

Santamarina

et al. 2019

WestJEM

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Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

et al. 2019

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Background Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Methods Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. Results One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Conclusions Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.

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Geographical Variance in the Use of Tranexamic Acid for Major Trauma Patients

2019

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Background and Objectives: The CRASH-2 trial is the largest randomised control trial examining tranexamic acid (TXA) for injured patients. Since its publication, debate has arisen around whether results could be applied to mature trauma systems in developed nations, with global opinion divided. The aim of this study was to determine if, among trauma patients in or at significant risk of major haemorrhages, there is an association of geographic region with the proportion of patients that received tranexamic acid. Materials and Methods: We conducted a systematic review of the literature. Potentially eligible papers were first screened via title and abstract screening. A full copy of the remaining papers was then obtained and screened for final inclusion. The Newcastle–Ottawa Scale for non-randomised control trials was used for quality assessment of the final studies included. A meta-analysis was conducted using a random-effects model, reporting variation in use sub-grouped by geographical location. Results: There were 727 papers identified through database searching and 23 manuscripts met the criteria for final inclusion in this review. There was a statistically significant variation in the use of TXA for included patients. Europe and Oceania had higher usage rates of TXA compared to other continents. Use of TXA in Asia and Africa was significantly less than other continents and varied use was observed in North America. Conclusions: A large geographical variance in the use of TXA for trauma patients in or at significant risk of major haemorrhage currently exists. The populations in Asia and Africa, where the results of CRASH-2 could be most readily generalised to, reported low rates of use. The reason why remains unclear and further research is required to standardise the use of TXA for trauma resuscitation.

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Empleo de ácido tranexámico en el herido de combate, experiencia de la sanidad militar española. Serie de casos y revisión de la literatura

Cited by 3 publications

References 30 publications

Mortality and Thrombosis in Injured Adults Receiving Tranexamic Acid in the Post-CRASH-2 Era

Mortality and Thrombosis in Injured Adults Receiving Tranexamic Acid in the Post-CRASH-2 Era

Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

Geographical Variance in the Use of Tranexamic Acid for Major Trauma Patients

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