Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study

Abstract

To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. Design: Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (Ն10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival. Setting: A Role 3 Echelon surgical hospital in southern Afghanistan. Patients: A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries. Main Outcome Measures: Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications. Results: The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P=.03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P Ͻ .001). This benefit was greatest in the group of patients who received massive transfusion (14.4% vs 28.1%, respectively; P=.004), where TXA was also independently associated with survival (odds ra-tio=7.228; 95% CI, 3.016-17.322) and less coagulopathy (P=.003). Conclusions: The use of TXA with blood componentbased resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.

Pediatric Combat Trauma

“…Timely administration of tranexamic acid (TXA) is associated with reduced morbidity and mortality in hemorrhaging adult trauma patients [40][41][42]. The international CRASH-2 trial was followed by a critical appraisal of TXA utility in the combat trauma setting for adults and was found to be even more beneficial than in civilian trauma.…”

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

“…28 A retrospective study by Morrison et al has reinforced this concept with 896 combat casualties, demonstrating the effect of tranexamic acid to be greater in more severely injured patients and those requiring massive transfusions. 29 In this study, only 7 patients needed to be treated to confer a mortality benefit, compared with 67 in CRASH-2. 28 Antifibrinolytic and anti-inflammatory effects are considered responsible pathways, and despite uncharacterised potential risks of venous thrombosis and embolus, the overall benefit of tranexamic acid seems to outweigh the risks, especially in those severely injured.…”

Haemorrhage and coagulopathy in the Defence Medical Services

“…The CRASH-2 [25] and MATTERS [26] studies demonstrated a survival benefit with tranexamic acid in civilian and military trauma, and this is now given routinely as part of the UK-DMS massive transfusion protocol. Although early case series of recombinant human activated factor VII (rFVIIa) appeared promising, a subsequent randomised control trial [27] was abandoned due to lack of apparent benefit and rFVIIa is now used only rarely by the UK-DMS in cases of refractory coagulopathic bleeding.…”