Zeitschrift für Trauma und Behandlung

Tranexamic Acid use in Trauma: Effective but not Without Consequences

Abstract

Haruka Swendsen , Joseph M Galante, Garth H Utter, Sarah Bateni , Lynette A Scherer, Carol R Schermer

Background: Administration of tranexamic acid (TXA) is associated with reduced mortality in civilian and military settings. The purpose of this study was to assess a TXA treatment guideline in patients with traumatic injury in a Level I trauma center. The guideline was to give TXA to patients going directly to OR, or with SBP < 90, or for whom our massive transfusion guideline was activated. The hypothesis was that TXA would confer mortality benefit without increasing thromboembolic complications (DVT/PE) or acute kidney injury (AKI).

Methods: Records of TXA recipients were reviewed. TXA recipients were compared to a random sample of historical controls that met administration criteria but did not receive TXA. Outcomes were compared for patients meeting any criteria for TXA administration and also for those going directly to the OR.

Results: From Dec 2011 through July 2012, 52 trauma patients received TXA. When compared to 74 controls (SBP < 90), TXA recipients trended towards lower mortality (5.8% vs 17.6%, p=.05), higher DVT/PE (11.5% vs 0, p=.004), and more AKI (25% vs11%, p=.02). However baseline characteristics were not well matched. When controls were selected from hypotensive patients going directly the OR, baseline matching was excellent. Among well matched direct to the OR cohorts TXA recipients had lower 24h mortality (4.3% vs 19.1%, p=.03), more DVT/PE (12% vs 0%, p=.012), a trend towards more AKI (28% vs 15%, p=.12) but no transfusion differences.

Conclusion: In civilian trauma, early TXA administration confers early survival advantage without affecting blood product usage but may increase the risk of DVT/PE and AKI.