Tranexamic acid administration to pediatric trauma patients in a combat setting

Eckert, Matthew J.; Wertin, Thomas M.; Tyner, Stuart D.; Nelson, Daniel W.; Izenberg, Seth; Martin, Matthew J.

doi:10.1097/ta.0000000000000443

Cited by 135 publications

(82 citation statements)

References 23 publications

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“…7,8 These studies also contrast with the retrospective MATTERS study, which showed a survival benefit in severely injured military casualties treated with TXA. 20 In addition, two studies, one a prospective cohort study of civilian trauma patients 21 and the other a retrospective study in pediatric trauma patients, 22 showed TXA to be beneficial in hemorrhagic shock patients.…”

Section: Discussionmentioning

confidence: 98%

Double-blinded, placebo-controlled study of early tranexamic acid treatment in swine uncontrolled hemorrhage model

Sondeen

Hanson²,

Prince³

et al. 2016

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 98%

Double-blinded, placebo-controlled study of early tranexamic acid treatment in swine uncontrolled hemorrhage model

Sondeen

Hanson²,

Prince³

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…17 The CRASH-2 (Clinical Randomization of an Antifibrinolytic in Significant Haemorrhage-2) randomized controlled trial, which enrolled 20,211 adults with hemorrhagic trauma in 40 countries, demonstrated that TXA decreased mortality at 28 days compared to placebo (risk of death 0.91; 95%CI 0.85 to 0.97) and had an even greater impact on death due to hemorrhage (risk of death due to hemorrhage OR, 95% CI). 17 Based on the results of this adult trial and that of an observational pediatric study that also demonstrated improved survival associated with TXA use, 9 some experts have advocated for the use of TXA in injured children with potentially hemorrhagic injuries. 10 In the UK, the Royal College of Paediatrics and Child Health and the Neonatal and Paediatric Pharmacists Group issued an evidence statement recommending a pragmatic dosage of TXA for children with major trauma.…”

Section: Discussionmentioning

confidence: 99%

“…A single retrospective cohort study of 766 injured children in Afghanistan reported that TXA was only used in 10% of pediatric trauma admissions, although its administration was independently associated with a 27% reduction in mortality (p=0.03). 9 …”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Use in United States Children's Hospitals

Nishijima

Monuteaux

Faraoni

et al. 2016

The Journal of Emergency Medicine

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Background The prevalence of tranexamic acid (TXA) use for trauma and other conditions in children is unknown. Objective The objective of this study was to describe the use of TXA in US children’s hospitals for children in general, and specifically for trauma. Methods We conducted a secondary analysis of a large, administrative database of 36 US children’s hospitals. We included children younger than 18 years who received TXA (based on pharmacy charge codes) from 2009 to 2013. Patients were grouped into the following diagnostic categories: trauma, congenital heart surgery, scoliosis surgery, craniosynostosis/craniofacial surgery, and other, based on ICD-9 principle procedure and diagnostic codes. TXA administration and dosage, in-hospital clinical variables, and diagnostic and procedure codes were documented. Results A total of 35,478 pediatric encounters with a TXA charge were included in the study cohort. The proportions of children who received TXA were similar across the years 2009–2013. Only 110 encounters (0.31%) were for traumatic conditions. Congenital heart surgery accounted for more than one-half of the encounters (22,863, 64%).. Overall the median estimated weight-based dose of TXA was 22.4 mg/kg (IQR 7.3 to 84.9 mg/kg). Conclusions We identified a wide frequency of use and range of doses of TXA for several diagnostic conditions in children. The use of TXA among injured children, however, appears to be rare despite its common use and efficacy among injured adults. Further work is needed to recommend appropriate indications for TXA, and provide dosage guidelines among children with a variety of conditions, including trauma.

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“…5 A recent evaluation of the use of TXA among pediatric trauma patients in a combat setting (PED-TRAX) identified an independent association between the administration of TXA and decreased mortality without safety or medicationrelated complications. 17 The ability to translate these adult and preliminary findings broadly to pediatric patients may have important implications for the future of pediatric trauma care. There are several limitations to our study.…”

Section: Article In Pressmentioning

confidence: 99%