The incidence of venous thromboembolic events in trauma patients after tranexamic acid administration: an EAST multicenter study

Rivas, Lisbi; Estroff, Jordan; Sparks, Andrew; Nahmias, Jeffry; Allen, Rebecca; Smith, Savannah; Kutcher, Matthew; Carter, Kristen; Grigorian, Areg; Albertson, Spencer; Turay, David; Quispe, Juan C.; Luo-Owen, Xian; Vella, Michael A.; Pascual, José L.; Tororello, Gabriella; Quattrone, McKell; Bernard, Andrew C.; Ratnasekera, Ashanthi; Lee, Alice; Tamburrini, Danielle; Rodríguez, Carlos J.; Harrell, Kelly; Jeyamurugan, Kokila; Bugaev, Nikolay; Warner, Alan; Weinberger, Jason; Hazelton, Joshua P.; Selevany, Mariam; Wright, Franklin L.; Kovar, Alexandra; Urban, Shane; Hamrick, Amy V; Mount, Michael; Carrick, Matthew M.; Cullinane, Daniel C.; Chang, Grace; Jain, Gary; Spalding, Chance; Sarani, Babak

doi:10.1097/mbc.0000000000000983

Cited by 14 publications

(9 citation statements)

References 17 publications

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“…However, concerns have been raised that indiscriminate widespread adoption might result in TXA administration in the wrong patients, leading to increased morbidity and mortality [6][7][8][9]. Data in the literature have been contradicting, however, with others reporting no significant differences or even decreased adverse effects [10][11][12][13][14]. At present, it remains unclear what the exact mechanism behind TXA is and how it has reduced mortality in CRASH-2 trial, since there was no reduction in packed red blood cells (PRBC) transfusion between patients who received TXA and the ones who did not [5].…”

Section: Introductionmentioning

confidence: 99%

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Wessem

Leenen

2021

World j. surg.

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Background Early hemorrhage control is important in trauma-related death prevention. Tranexamic acid (TXA) has shown to be beneficial in patients in hemorrhagic shock, although widespread adoption might result in incorrect TXA administration leading to increased morbidity and mortality. Methods A 7-year prospective cohort study with consecutive trauma patients admitted to a Level-1 Trauma Center ICU was performed to investigate administration of both pre- and in-hospital TXA and its relation to morbidity and mortality. Indication for prehospital and in-hospital TXA administration was (suspicion of) hemorrhagic shock, and/or systolic blood pressure (SBP) ≤ 90 mmHg. Demographics, data on physiology, resuscitation and outcomes were prospectively collected. Results Four hundred and twenty-two patients (71% males, median ISS 29, 95% blunt injuries) were included. Even though TXA patients were more severely injured with more deranged physiology, no differences in outcome were noted. Overall, thrombo-embolic complication rate was 8%. In half the patients, hemorrhagic shock was the indication for prehospital TXA, whereas 79% of in-hospital TXA was given based on suspicion of hemorrhagic shock. Thirteen percent of patients with SBP ≤ 90 mmHg in ED received no TXA at all. Based on SBP alone, 22% of prehospital TXA and 25% of in-hospital TXA were justified. Conclusions Despite being more severely injured, TXA patients had similar outcome compared to patients without TXA. Thrombo-embolic complication rate was low despite liberal use of both prehospital and in-hospital TXA. Caution should be exercised in selecting patients for TXA, although this might be challenging based on SBP alone in patients who do not yet show signs of deranged physiology on arrival in ED.

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Section: Introductionmentioning

confidence: 99%

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Wessem

Leenen

2021

World j. surg.

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“…From those studies, we only included thirty-seven trials for full-text evaluation. Finally, 17 studies were found to be eligible for quantitative analysis [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. The details of the selected trials are summarized in Table 1 and Table S1.…”

Section: Characteristics Of Studies Included In the Meta-analysismentioning

confidence: 99%

“…The details of the selected trials are summarized in Table 1 and Table S1. Among the seventeen studies, four studies were carried out in combat conditions [23,27,29,30], and 13 studies were carried out on civilian injuries [24][25][26]28,[31][32][33][34][35][36][37][38][39]. Three studies were designed as randomized controlled trials [26,28,36].…”

Section: Characteristics Of Studies Included In the Meta-analysismentioning

confidence: 99%

“…The sample sizes of the included studies ranged from 40 to 20,207, with a total of 30,571 individuals, which altogether included patients with trauma treated with TXA (n = 14,413) or non-TXA (n = 16,158). Among the 17 articles, eight were conducted in USA [23,26,27,[31][32][33]35,37,38], and one in each of the following countries: UK [24], Qatar [25], Iran [28], Israel [29], Afghanistan [30], Canada [34], and Germany [39]. One study was also conducted as a multi-country trial [36].…”

Section: Characteristics Of Studies Included In the Meta-analysismentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid in Emergency Trauma: A Systematic Review and Meta-Analysis

Al-Jeabory¹,

Szarpak

Attila³

et al. 2021

JCM

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In trauma patients, bleeding can lead to coagulopathy, hemorrhagic shock, and multiorgan failure, and therefore is of fundamental significance in regard to early morbidity. We conducted a meta-analysis to evaluate the efficacy and safety of tranexamic acid (TXA) in civil and military settings and its impact on in-hospital mortality (survival to hospital discharge or 30-day survival), intensive care unit and hospital length of stay, incidence of adverse events (myocardial infarct and neurological complications), and volume of blood product transfusion. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature using PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Central Register and Controlled Trials (CENTRAL) database was conducted from inception to 10 January 2021. In-hospital mortality was reported in 14 studies and was 15.5% for the TXA group as compared with 16.4% for the non-TXA group (OR = 0.81, 95% CI 0.62–1.06, I2 = 83%, p = 0.12). In a civilian TXA application, in-hospital mortality in the TXA and non-TXA groups amounted to 15.0% and 17.1%, respectively (OR = 0.69, 95% CI 0.51–0.93, p = 0.02, I2 = 78%). A subgroup analysis of the randomized control trial (RCT) studies showed a statistically significant reduction in in-hospital mortality in the TXA group (14.3%) as compared with the non-TXA group (15.7%, OR = 0.89, 95% CI 0.83–0.96, p = 0.003, I2 = 0%). To summarize, TXA used in civilian application reduces in-hospital mortality. Application of TXA is beneficial for severely injured patients who undergoing shock and require massive blood transfusions. Patients who undergo treatment with TXA should be monitored for clinical signs of thromboembolism, since TXA is a standalone risk factor of a thromboembolic event and the D-dimers in traumatic patients are almost always elevated.

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“…Following the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage 2 trial (CRASH-2) (3), its use was adopted worldwide for this indication, initially in trauma centers and later in the prehospital setting. In subsequent trials, it has been found beneficial for severely injured casualties suffering from hemorrhagic shock requiring massive transfusions (4, 5).…”

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confidence: 99%

Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry

Gendler

Gelikas

Talmy

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES:Tranexamic acid (TXA) administration confers a survival benefit in bleeding trauma patients; however, data regarding its use in pediatric patients are limited. This study evaluates the prehospital treatment with TXA in pediatric trauma patients treated by the Israel Defense Forces Medical Corps (IDF-MC). DESIGN:Retrospective, cohort study using the Israel Defense Forces registry, 2011-2021. PATIENTS:Pediatric trauma patients less than 18 years old. We excluded patients pronounced dead at the scene. INTERVENTIONS: None.SETTING: All cases of pediatric trauma in the registry were assessed for treatment with TXA. Propensity score matching was used to assess the association between prehospital TXA administration and mortality. MEASUREMENTS AND MAIN RESULTS:Overall, 911 pediatric trauma patients were treated with TXA by the IDF-MC teams; the median (interquartile) age was 10 years (5-15 yr), and 72.8% were male. Seventy patients (7.6%) received TXA, with 52 of 70 (74%) receiving a 1,000 mg dose (range 200-1,000 mg). There were no prehospital adverse events associated with the use of TXA (upper limit of 95% CI for 0/70 is 4.3%). Compared with pediatric patients who did not receive TXA, patients receiving TXA were more likely to suffer from shock (40% vs 10.7%; p < 0.001), sustain more penetrating injuries (72.9% vs 31.7%; p < 0.001), be treated with plasma or crystalloids (62.9% vs 11.4%; p < 0.001), and undergo more lifesaving interventions (24.3% vs 6.2%; p < 0.001). The propensity score matching failed to identify an association between TXA and lesser odds of mortality, although a lack of effect (or even adverse effect) could not be excluded (non-TXA: 7.1% vs TXA: 4.3%, odds ratio = 0.584; 95% CI 0.084-3.143; p = 0.718). CONCLUSIONS:Although prehospital TXA administration in the pediatric population is feasible with adverse event rate under 5%, more research is needed to determine the appropriate approach to pediatric hemostatic resuscitation and the role of TXA in this population.

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The incidence of venous thromboembolic events in trauma patients after tranexamic acid administration: an EAST multicenter study

Cited by 14 publications

References 17 publications

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Efficacy and Safety of Tranexamic Acid in Emergency Trauma: A Systematic Review and Meta-Analysis

Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry

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