In this episode, I’ll discuss prehospital tranexamic acid (TXA) for trauma patients.
The CRASH-2 study solidified the role of TXA in trauma patients once they get to the hospital, and many investigators have since examined whether moving TXA administration earlier in care to the prehospital setting is beneficial.
The CRASH-3 and STAAMP trials did not deliver the convincing evidence that was hoped for, but that has not stopped some regional services from using TXA in the prehospital setting.
In Germany, EMS has given prehospital TXA to trauma patients for several years, and a group of authors has published in the journal Critical Care a retrospective cohort study looking at prehospital TXA in a real-world setting.
A cohort of over 2000 patients in each of the TXA and control groups was analyzed. Patients who received TXA were more often transfused than controls, however the TXA group needed significantly less packed red blood cells and fresh frozen plasma when transfused.
The massive transfusion rate was also significantly lower in the TXA group at 5.5% vs 7.2%.
Mortality was no different except at two early timepoints – 6 and 12 hours where it was lower for the TXA group.
There was not a significant difference in thromboembolic events between groups.
One interesting point this article raises is whether there is a dose-dependent effect of TXA or whether the prehospital administration is responsible for the beneficial effects. This is because one-third of patients in both the prehospital TXA and control groups also received TXA when they arrived to the hospital. Therefore the TXA group had some patients receiving two doses of TXA.
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