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

Abstract

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.

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

“…Moreover, TXA administration may increase the risk of thromboembolic complications, particularly when higher or repeated doses are used as shown in the MATTERS and HALT-IT trials [21,30,31]. Moreover, there are few studies on the efficacy and safety of TXA en route to the hospital or at the scene [20,[32][33][34][35].…”

“…In few countries, prehospital TXA is considered standard of care for injured adult patients at risk of hemorrhage and more recently head injury [ 7 , 16 – 18 , 32 , 36 , 37 ]. However, a recent report found a large geographical variance in the use of TXA in trauma, particularly in Asia and Africa [ 33 ]. The present randomized controlled trial (RCT) aimed to evaluate the safety and efficacy of the second in-hospital dose of TXA versus placebo on mortality and complications in adult trauma patients receiving the first TXA dose prehospitally.…”

Tranexamic acid for major trauma patients in Ireland

“…This fi nding was in keeping with current literature that shows uptake of TXA post-publication of CRASH-2 has not been universal. [10] One reason that may contribute to the lower implementation of TXA in Ireland compared to the UK, is the lack of a coordinated national trauma system in Ireland. Without a coordinated national system, no national statutory body exists to standardize and provide governance for trauma patients in Ireland.…”

“…However, this uptake has not been universal in other nations, and currently there exists significant geographical variance in the use of TXA for trauma patients. [10] A postulated reason for this variation relates to generalisability with many patients in CRASH-2 enrolled from developing nations, which commonly lack ready access to advanced processes and interventions in mature trauma systems. [11,12] Geographically, Ireland is the closest nation to the UK.…”

Characteristics and Outcomes of Liver Transplantation Recipients after Tranexamic Acid Treatment and Platelet Transfusion: A Retrospective Single-Centre Experience

“…Nevertheless, its clinical use is still limited in current practice due to serious complications concerning thrombosis formation. Furthermore, Walsh and colleagues have reported geographical variations in the use of TXA among trauma patients [ 17 ]. Countries of Asia and Africa were among those who have reported a lower use of TXA.…”