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

Stein, Philipp; Studt, Jan‐Dirk; Albrecht, Roland; Müller, Stefan A.; Ow, Dieter von; Fischer, Simon; Seifert, Burkhardt; Mariotti, S; Spahn, Donat R.; Theusinger, Oliver M.

doi:10.1213/ane.0000000000002708

Cited by 35 publications

(19 citation statements)

References 35 publications

(46 reference statements)

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“…This is in keeping with a recent study demonstrating the benefit of on-scene administration of TXA in patients with major trauma. In this study, the normally occurring deterioration of the coagulation status between the site of injury and hospital admission was clearly mitigated by the on-scene TXA administration [504].…”

Section: Resultsmentioning

confidence: 99%

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The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultsmentioning

confidence: 99%

“…Thus, TXA should be included as part of each institutional “trauma management protocol” not the “massive blood loss” or “major haemorrhage” protocols. The benefit of on-scene TXA administration has recently been shown to be independent of the severity of injury [504].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…Apart from these road safety issues, numerous changes have been made in clinical patient management. There is no doubt that more precise identification of the patient at risk for complications in the early stages after trauma is available (6)(7)(8)(9). Also, there is a higher awareness of life-threatening complications (10)(11)(12)(13), possibly related to the availability of numerous clinical parameters and biomarkers for the prediction of clinical complications (14 -17).…”

Section: Resultsmentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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Objectives Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. Methods I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). Results I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. Conclusions Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.

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“…This is also supported in the literature, which differs in terms of its design, scope, and objectives. 20,21 The findings showed that efforts must be instigated for reducing the struggles of the medical provider. This means ensuring the presence of computed scam, blood bank, tomography scan, and more for meeting the care needs of the trauma patients.…”

Section: Discussionmentioning

confidence: 99%

<p>Relationship Between Initial Arterial Blood Gases and Coagulation Profiles – Analyzing the Prognosis and Outcomes in Patients with Multiple Injuries/Trauma</p>

Raffee

Alawneh

Alustath

2020

OAEM

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Purpose: Trauma is recognized as a significant health concern across the world. The increase in the mortality rate of multiple trauma (MT) patients serves as a major issue for health-care providers. The study investigates the relationship between the initial arterial blood gases and coagulation profiles among the multiple injured/trauma patients. Results: The results showed that patients were mainly male (79.6%) and had RTA (71.5%). They had a normal pH (50.4%) and pCO2 (68.6%) while decreasing HCO3 (51.1%). An increasing level of pCO2 (45%) along with PT (28%), PTT (17%) and INR (23%) is observed. It also showed a decreasing level of platelets (39%). The overall findings showed a close association of the blood gases and coagulation indicators. Conclusion: The study concludes that to control the coagulation markers, the blood gases of the patients should be screened and monitored.

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

Abstract: Early prehospital administration of TXA leads to clot stabilization and a reduction of fibrinolytic activity, causing a decrease in fibrin degradation products buildup (D-dimer).

Cited by 35 publications

References 35 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

<p>Relationship Between Initial Arterial Blood Gases and Coagulation Profiles – Analyzing the Prognosis and Outcomes in Patients with Multiple Injuries/Trauma</p>

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