R. S. Jawa1, A. Singer2, J. E. McCormack1, C. Huang1, J. A. Vosswinkel1 1Stony Brook University Medical Center,Trauma,Stony Brook, NEW YORK, USA 2Stony Brook University Medical Center,Emergency Medicine,Stony Brook, NY, USA
Introduction: The antifibrinolytic tranexamic acid (TXA) is listed as essential medication by the World Health Organization, is included in the Joint Theater Trauma System, and is recommended by the Trauma Quality Improvement Program of the American College of Surgeons as part of massive transfusion guidelines. A recent major trauma study further advocated for TXA use. However, its use in US trauma centers is unknown. We determined surgeon’s familiarity with TXA and use of TXA. We further hypothesized that military experience would be associated with greater TXA familiarity and use.
Methods: An online survey was sent to the 1291 attending surgeon members of a national trauma organization in the spring of 2014. The survey was organized into three parts: respondent demographics, perceptions of TXA, and experience with TXA. Perceptions of TXA use were scored on a 5 point Likert scale. Chi-squared test was used for statistical analysis and p<0.05 was considered significant.
Results: The survey was completed by 35%. With regards to demographics, 81.1% had completed a Critical Care fellowship. Military medical experience was reported by 21.0%. 74.5% of respondents work in a Level 1 Trauma Center, and 23% in a Level II trauma center.
With regards to TXA perceptions, a majority of those surveyed agreed or strongly agreed that: TXA reduced bleeding (78.9%), and that a comprehensive massive transfusion protocol should include TXA (82.5%). Furthermore, 92% of respondents are looking towards national trauma organizations to develop practice guidelines for its use.
Experience with TXA was variable: 38.0% use regularly, 24.9% use it 1-2 times per year, 12.3% use it rarely, and 24.7% have not used it. Of those who had used TXA, 79.6% indicated that the primary indication is significant hemorrhage; 18.6% felt risk of significant bleeding was an indication. Amongst respondents who did not routinely use TXA, the primary reason was that they felt that TXA had uncertain clinical benefit (48.3%), followed by unfamiliarity with the drug (32.8%). TXA unavailability in the hospital was a rare cause (3.6%); 87.2% of respondent's hospitals had TXA on formulary. While 18.3% of surgeons with military experience had never used TXA, 26.4% of those without military experience had not used TXA, but this failed to reached statistical significance, with p=0.11.
Conclusion: Currently, only 38% of US trauma surgeons regularly use TXA for significant traumatic hemorrhage. The major reason for this appears to be unfamiliarity with TXA. Military experience was not a significant predictor of TXA use in civilian US trauma centers. The data suggest an opportunity for collaboration amongst members of national organizations to further a guideline for TXA use in significant hemorrhage.