T. Kheirbek1, N. Jikaria1, B. Murray2, S. N. Leuckel1, S. F. Monaghan1, A. H. Stephen1, D. T. Harrington1, C. A. Adams1 1Brown University School Of Medicine,Surgery,Providence, RI, USA 2Brown University School Of Medicine,Emergency Medicine,Providence, RI, USA
Introduction: Early administration of tranexamic acid (TXA) has been widely implemented to prevent fibrinolysis in hemorrhagic shock. Prehospital use of emergency medical services (EMS) has become popular for suspected hemorrhage. We aimed to assess the rate of liberal use of TXA, and whether non-therapeutic administration was associated with increased thrombotic events.
Methods: We identified injured patients who received TXA between 1/2016-1/2018 by querying our level 1 trauma center's registry. We excluded patients who received TXA in the operating room for orthopedic procedures. We retrospectively reviewed medical records and radiologic images to classify whether patients had a hemorrhagic injury that would have benefited from TXA (Therapeutic Administration, TA), or not (Non-Therapeutic Administration, NTA). Demographics, injury patterns, physiologic data, as well as venous thrombotic events (VTE) and mortality rates were compared between the two groups. VTE was diagnosed by duplex ultrasound or computed tomography.
Results: Ninety-five patients received TXA for traumatic injuries, and 42% were given by EMS. TXA was considered non-therapeutic in 34/95 patients retrospectively (NTA group, 35.8%), and in 52% of the patients when given by EMS. Compared to those in NTA group, patients in TA group were younger (47.6 vs. 58.4, p=0.02) and more hypotensive in the field (systolic blood pressure, SBP: 107?31 vs. 137?32 mmHg, p<0.001) and in the emergency department (ED – SBP: 97?27 vs 128 ? 27, p<0.001). They were more tachycardic in ED (heart rate: 99?29 vs. 88?19, p=0.04). TA group had higher injury severity score (ISS – median 24 v 11, p<0.001), was transfused more often (81.7% vs 20.6%, p<0.001), and had higher in-hospital mortality (39.3% vs 2.9%, p<0.001), but there was no difference in the rate of VTE (8.2% vs 5.9%, NS). There was a higher rate of non-therapeutic use when TXA was given by Basic Life Support (BLS) units compared to Advanced Life Support (ALS) units (91.7% vs 42%).
Conclusion: Our results highlight a significantly high rate of non-therapeutic administration, especially by EMS. Hypotension and tachycardia were indications of correct use. There was no difference in VTE rates between the groups, but the low incidence rate limits our conclusion and a larger study is warranted. Cautious implementation of TXA in resuscitation protocols is encouraged in the meantime.