Tranexamic acid for major trauma patients in Ireland

doi:10.5847/wjem.j.1920-8642.2022.003

Abstract

Abstract:

BACKGROUND: The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2 (CRASH-2) is the largest randomized control trial (RCT) examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid (TXA) within 3 hours of injury. Since the publication of CRASH-2, significant geographical variance in the use of TXA for trauma patients exists. This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.
METHODS: A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network (TARN). All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation (as defined by systolic blood pressure [SBP] <100 mmHg [1 mmHg=0.133 kPa] and administration of blood products) were eligible for inclusion. Death at hospital discharge was the primary outcome.
RESULTS: During the study period, a total of 234 patients met the inclusion criteria. Among injured patients presenting with hemorrhagic shock, 133 (56.8%; 95% confidence interval [CI] 50.2%-63.3%) received TXA. Of patients that received TXA, a higher proportion of patients presented with shock index >1 (70.68% vs.57.43%) and higher Injury Severity Score (ISS >25; 49.62% vs. 23.76%). Administration of TXA was not associated with mortality at hospital discharge (odds ratio [OR] 0.86, 95% CI 0.31-2.38).
CONCLUSIONS: Among injured Irish patients presenting with hemorrhagic shock, TXA was administered to 56.8% of patients. Patients administered with TXA were on average more severely injured. However, a mortality benefit could not be demonstrated.

Key words: Tranexamic acid, Shock, Ireland, Hemorrhage

Kieran Walsh, Francis O’Keeffe, Louise Brent, Biswadev Mitra. Tranexamic acid for major trauma patients in Ireland[J]. World Journal of Emergency Medicine, 2022, 13(1): 11-17.

Figures/Tables 4

Table 1

Figure 1.

Table 2

Figure 2.

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Variables	TXA not administered (n=101)	TXA administered (n=133)	P-value
Age, n (%) 0-10 years 11-20 years 21-40 years 41-65 years >65 years	10 (9.90) 6 (5.94) 27 (26.73) 22 (21.78) 36 (35.64)	1 (0.75) 9 (6.77) 50 (37.39) 40 (30.08) 33 (24.81)	0.002
Sex (male), n (%)	55 (54.46)	99 (74.44)	0.001
Injury mechanism, n (%) Vehicle Penetrating High fall Low fall Other blunt Other	19 (18.81) 14 (13.86) 12 (11.88) 44 (43.56) 9 (8.91) 3 (2.97)	68 (51.13) 26 (19.55) 15 (11.28) 17 (12.78) 6 (4.51) 1 (0.75)	<0.001
Penetrating trauma, n (%)	15 (14.85)	30 (22.56)	0.140
Ambulance/helicopter, n (%)	81 (80.20)	128 (96.24)	<0.001
ED SBP^a, mmHg	77.9±20.5	75.5±21.1	0.390
ED SI >1, n (%)	58 (57.43)	94 (70.68)	0.030
ED GCS^b, n (%) 3-8 9-12 13-15	24 (23.76) 7 (6.93) 67 (66.36)	38 (28.57) 12 (9.02) 82 (61.65)	0.610
ED pulse rate^a, beats/minute	88.7±32.8	96.4±35.7	0.100
ISS, n (%) 0-12 13-25 >25	31 (30.69) 46 (45.54) 24 (23.76)	29 (21.80) 38 (28.57) 66 (49.62)	<0.001

Variables	Adjusted OR (95% CI)	P-value
TXA	0.86 (0.31-2.38)	0.770
Male sex	3.30 (1.14-9.50)	0.027
Helicopter transport	12.90 (0.47-326.70)	0.130
ED SBP	0.96 (0.93-0.98)	0.002
ED pulse	0.96 (0.90-1.02)	0.220
ED GCS	0.98 (0.92-1.03)	0.490
ISS	1.07 (1.04-1.11)	<0.001

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