The study: This was a retrospective, observational, cohort study enrolling 896 trauma patients who had received at least 1 unit of packed red blood cells after admission to a single surgical hospital at Camp Bastion in Southern Afghanistan following a combat related injury. They compared the group of patients who had received tranexamic acid to those who had not received it.
-Mortality at 24hrs, 48 hrs, & 30 days
-Coagulation parameters (prothrombin time & activated partial thromboplastin time): measured at 2 points: (1) admission to the ED of the surgical hospital & (2) admission to the ICU following OT
-Incidence of thrombotic events such as DVT or PE
-There was no statistically significant survival benefit using TXA within 24 hrs in either the overall group or the massive transfusion group.
-There was an overall mortality reduction in the TXA group within 48 hrs (11.3% vs 18.9% p value 0.004) & In-hospital mortality (17.4% vs 23.9% p value 0.03).
-There was a significant mortality reduction in the TXA arm of the massive transfusion group within 48hrs (10.4% vs 23.5% p value 0.003) & in-hospital mortality (14.4% vs 28.1% p value 0.004)
-In the overall group there was a statistically significant increase in the amount of all blood products (PRBC, FFP, Platelets & cryoprecipitate) used in the TXA group. This may reflect the increased severity in this group.
-In both the overall & massive transfusion cohorts there was a statistically significant reduction in hypocoagulation in the TXA groups when comparing the patients bloods taken in emergency to their bloods taken in ICU following OT.
-In the TXA group there was a statistically significant increase in the number of pulmonary embolisms (2.7% vs 0.3% p value .001) & deep vein thrombosis (2.4% vs 0.2% p value .001). The number of venous thrombotic events in this study is too small to assess any independent risk of TXA. Due to the reduction in hypocoagulation it is plausible that the higher rates of thrombotic events relate to the TXA.
-This study suggests a survival benefit to giving tranexamic acid to bleeding trauma patients. This article suggests that this may be linked to clot stabilisation & reduction in inflammation.
-We should be considering tranexamic acid in bleeding trauma patients, particularly if they are haemodynamically unstable.
-TXA is included in our massive transfusion protocol.
Link to the article
Link to the full appraisal
Link to our massive transfusion protocol