Unjustified Administration in Liberal Use of Tranexamic Acid in Trauma Resuscitation

Kheirbek, Tareq; Jikaria, Neil; Murray, Brett; Martin, Thomas J.; Lueckel, Stephanie N.; Stephen, Andrew H.; Monaghan, Sean F.; Adams, Charles A.

doi:10.1016/j.jss.2020.08.045

Cited by 2 publications

(2 citation statements)

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“…This liberal approach of prehospital TXA administration even increased over time during the 7-year study and has recently also been described by Kheirbek et al Despite large numbers of unjustified TXA use, they also did not demonstrate difference in TEC [23].…”

Section: Discussionsupporting

confidence: 73%

“…In this study, 422 patients (71% male) with a median age of 46 (28-62) years admitted to ICU were included. Ninetyfive percent of injuries were caused by a blunt mechanism, 50% was prehospitally intubated, and median ISS was 29 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) with most severe injuries located in the brain (AIS head 3 (1-4)) and chest (AIS chest 3 (2-4)). One hundred and three patients (24%) underwent an urgent laparotomy.…”

Section: Resultsmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 73%

Section: Resultsmentioning

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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Prehospital shock index outperforms hypotension alone in predicting significant injury in trauma patients

Kheirbek

Martin

Cao

et al. 2021

Trauma Surg Acute Care Open

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BackgroundThe American College of Surgeons Resources for Optimal Care of the Injured Patient recommends using hypotension, defined as systolic blood pressure ≤90 mm Hg, as an indicator of a full team trauma activation. We hypothesized that an elevated shock index (SI) predicts significant traumatic injuries better than hypotension alone.MethodsThis is a retrospective cohort study analyzing full team trauma activations between February 2018 and January 2020, excluding transfers and those who had missing values for prehospital blood pressure or heart rate. We reviewed patients’ demographics, prehospital and emergency department vitals, injury pattern, need for operation, and clinical outcomes. The primary outcome was rate of significant injury defined as identified injured liver, spleen, or kidney, pelvis fracture, long bone fracture, significant extremity soft tissue damage, hemothorax, or pneumothorax.ResultsAmong 544 patients, 82 (15.1%) had prehospital hypotension and 492 had normal blood pressure. Of the patients with prehospital hypotension, 34 (41.5%) had a significant injury. There was no difference in age, gender, medical history, or injury pattern between the two groups. There was no difference between the two groups in rate of serious injury (41.5% vs. 46.1%, NS), need for emergent operation (31.7% vs. 28.1%, NS) or death (20.7% vs. 18.8%, NS). On the other hand, SI ≥1 was associated with increased rate of serious injury (54.6% vs. 43.4%, p=0.04). On a logistic regression analysis, prehospital hypotension was not associated with significant injury or need for emergent operation (OR 0.83, 95% CI 0.51 to 1.33 and OR 1.32, 95% CI 0.79 to 2.25, respectively). SI ≥1 was associated with both increased odds of significant injury and need for emergent operation (OR 1.57, 95% CI 1.01 to 2.44 and OR 1.64, 95% CI 1.01 to 2.66).DiscussionSI was a better indicator and could replace hypotension to better categorize and triage patients in need of higher level of care.Level of evidencePrognostic and epidemiologic, level III.

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Unjustified Administration in Liberal Use of Tranexamic Acid in Trauma Resuscitation

Cited by 2 publications

References 21 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

Prehospital shock index outperforms hypotension alone in predicting significant injury in trauma patients

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