Prehospital tranexamic acid may not lower hemorrhage risk in trauma patients: JAMA
USA: The administration of tranexamic acid before hospitalization in injured patients at hemorrhage risk although is safe but it did not significantly lower mortality risk, according to a recent study in the journal JAMA Surgery. Further, the administration of prehospital tranexamic acid within 1 hour of injury and in those having prehospital severe shock resulted in lower 30-day mortality. This necessarily means providing prehospital tranexamic acid during ground or air transport is safe and can be provided to patients at hemorrhage risk.
The administration of prehospital tranexamic acid during air or ground transport is safe and can be provided to patients at risk for hemorrhage.
Trauma is a leading cause of death worldwide. In-hospital administration of tranexamic acid after injury improves outcomes in patients at hemorrhage risk. However, there is a lack of data demonstrating the safety and benefit of tranexamic acid use before hospitalization in these patients.
Francis X. Guyette, University of Pittsburgh, Pittsburgh, Pennsylvania, and colleagues assessed the safety and effectiveness of tranexamic acid administered before hospitalization compared with placebo in injured patients at risk for hemorrhage.
The trial included injured patients with prehospital hypotension (systolic blood pressure ≤90 mm Hg) or tachycard ia (heart rate ≥110/min) before arrival at 1 of 4 US level 1 trauma centers. They had an estimated 2 hours of injury, from May 1, 2015, through October 31, 2019.
The patients were randomized to receive either 1 g of tranexamic acid (447 patients) or placebo (456 patients) before hospitalization. Both the interventions were infused for 10 minutes in 100 mL of saline.
The primary outcome was 30-day all-cause mortality.
Key findings of the study include:
- Mortality at 30 days was 8.1% in patients receiving tranexamic acid compared with 9.9% in patients receiving placebo (difference, –1.8%).
- Results of Cox proportional hazards regression analysis, accounting for site, verified that randomization to tranexamic acid was not associated with a significant reduction in 30-day mortality (hazard ratio, 0.81).
- Prespecified dosing regimens and post-hoc subgroup analyses found that prehospital tranexamic acid were associated with significantly lower 30-day mortality.
- When comparing tranexamic acid effect stratified by time to treatment and qualifying shock severity in a post hoc comparison, 30-day mortality was lower when tranexamic acid was administered within 1 hour of injury (4.6% vs 7.6%).
- Patients with severe shock (systolic blood pressure ≤70 mm Hg) who received tranexamic acid demonstrated lower 30-day mortality compared with placebo (18.5% vs 35.5%).
"Tranexamic acid given to injured patients at risk for hemorrhage in the prehospital setting is safe and associated with a survival benefit in specific subgroups of patients," concluded the authors.
The study, "Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial," is published in the journal JAMA Surgery.
DOI: https://jamanetwork.com/journals/jamasurgery/fullarticle/2771225
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