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Early Prehospital Tranexamic Acid Following Injury is Associated with a 30-day Survival Benefit: A Secondary Analysis of a Randomized Clinical Trial

Department of Surgery, University of Pittsburgh, Pittsburgh, PA Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA Division of Trauma and General Surgery, Pittsburgh Trauma Research Center, University of Pittsburgh, Pittsburgh, PA Department of Surgery, University of Texas Health San Antonio, San Antonio, TX Department of Surgery, University of Utah, Salt Lake City, UT Department of Surgery, University of Arizona, Tucson, AZ.

Annals of surgery. 2021
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PICO Summary

Population

Injured patients (n= 476).

Intervention

Prehospital tranexamic acid (TXA) within 1 hour from time of injury (Early group, n= 238).

Comparison

Prehospital TXA beyond 1 hour (Delayed group, n= 238).

Outcome

Patients from both groups had similar demographics, injury characteristics and shock severity but those in the delayed group had greater prehospital resuscitation requirements and longer prehospital times. Stratified Kaplan-Meier analysis demonstrated significant separation for those in the early group (log-rank chi-square test, 4.99) with no separation for patients in the delayed group (log-rank chi-square test, 0.04). Stratified Cox Hazard regression verified, after controlling for confounders, that early TXA was associated with a 65% lower independent hazard for 30-day mortality (HR 0.35) with no independent survival benefit found in delayed patients (HR 1.00). Early TXA patients had lower incidence of multiple organ failure and 6-hour and 24-hour transfusion requirements.
Abstract
OBJECTIVE We sought to characterize the timing of administration of prehospital Tranexamic Acid (TXA) and associated outcome benefits. BACKGROUND TXA has been shown to be safe in the prehospital setting post-injury. METHODS We performed a secondary analysis of a recent prehospital randomized TXA clinical trial in injured patients. Those who received prehospital TXA within 1hr (EARLY) from time of injury were compared to those who received prehospital TXA beyond 1hr (DELAYED). We included patients with a shock index of > 0.9. Primary outcome was 30-day mortality. Kaplan-Meier and Cox Hazard regression were utilized to characterize mortality relationships. RESULTS EARLY and DELAYED patients had similar demographics, injury characteristics and shock severity but DELAYED patients had greater prehospital resuscitation requirements and longer prehospital times. Stratified Kaplan-Meier analysis demonstrated significant separation for EARLY patients (N =238, log-rank chi-square test, 4.99; P = .03) with no separation for DELAYED patients (N=238, log-rank chi-square test, 0.04; P = .83). Stratified Cox Hazard regression verified, after controlling for confounders, that EARLY TXA was associated with a 65% lower independent hazard for 30-day mortality (HR 0.35, 95%CI 0.19-0.65, P = .001) with no independent survival benefit found in DELAYED patients (HR 1.00, 95%CI 0.63-1.59, P = .999). EARLY TXA patients had lower incidence of multiple organ failure and 6-hour and 24-hour transfusion requirements compared to placebo. CONCLUSIONS Administration of prehospital TXA within 1 hour from injury in patients at risk of hemorrhage is associated with 30-day survival benefit, lower incidence of multiple organ failure, and lower transfusion requirements.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine