Early administration of tranexamic acid improves trauma related mortality

Many trauma-related fatalities might be avoided by giving early tranexamic acid (TXA) to patients at risk of substantial bleeding, says an article published in BMC Emergency Medicine.

Early tranexamic acid delivery has been found to save lives in trauma patients, and certain emergency medical services (EMS) in the United States have started offering this treatment before hospitalization. State-by-state variations in treatment guidelines include offering TXA to all serious trauma patients, reserving it for those who fulfill certain vital sign requirements, and delaying TXA totally until a hospital review. In order to assess the preventable mortality rates that may be achieved under each of these tactics and to document the many methods employed by EMS, Matthew J. Bivens and colleagues conducted this study.

A cohort of trauma patients who died from 2007 to 2012 from bleeding was identified using National Center for Health Statistics underlying cause of death data. The National Trauma Data Bank was used to assess the percentage of fatalities if the patient had hypotension or a fast heartbeat. The landmark CRASH 2 study's avoidable mortality risk ratios were used to calculate the number of lives that might have been saved if TXA had been administered within an hour of the accident based on a clinician's assessment that the patient was at risk for significant hemorrhage, had it been reserved only for hypotensive or tachycardic patients, or had it been administered between hours one and three of the accident, which is used in this case as a stand-in for defer.

The key findings of this study were:

1. Nationally, 3409 fatalities may have been prevented on average each year if TXA had been administered within an hour of the accident.

2. 2236 fatalities a year may have been prevented if TXA had been administered during the first three hours following injury.

3. 1371 fatalities a year may have been avoided if TXA had only been administered to trauma patients who were either tachycardic or hypotensive.

4. 616 fatalities a year would have been avoided if TXA had only been administered to hypotensive trauma patients.

5. At the state level, comparable tendencies may be noticed.

6. 15 statewide policies that permit EMS providers to deliver TXA for trauma were discovered after an analysis of EMS procedures.

Reference:

Bivens, M. J., Fritz, C. L., Burke, R. C., Schoenfeld, D. W., & Pope, J. V. (2022). State-by-state estimates of avoidable trauma mortality with early and liberal versus delayed or restricted administration of tranexamic acid. In BMC Emergency Medicine (Vol. 22, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12873-022-00741-2