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A Retrospective Study of Transfusion Requirements in Trauma Patients Receiving Tranexamic Acid

Cornelius, Brian, DNP, CRNA, NRP; Moody, Kelsey, DO; Hopper, Katelyn, MD; Kilgore, Phillip, MS; Cvek, Urska, ScD, MBA; Trutschl, Marjan, ScD; Cornelius, Angela P., MD

doi: 10.1097/JTN.0000000000000437
RESEARCH
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The Military Application of Tranexamic Acid in Trauma Emergency Resuscitation Study (MATTERs) and Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) studies demonstrate that tranexamic acid (TXA) reduces mortality in patients with traumatic hemorrhage. However, their results, conducted in foreign countries and U.S. military soldiers, provoke concerns over generalizability to civilian trauma patients in the United States. We report the evaluation of patient outcomes and transfusion requirements following treatment with TXA by a civilian air medical program. We conducted a retrospective chart review of trauma patients transported by air service to a Level 1 trauma center. For the purposes of intervention evaluation, patients meeting this criterion for the 2 years (2012–2014) prior to therapy implementation were compared with patients treated during the 2-year study period (2014–2016). Goals were to evaluate morbidity, mortality, transfusion requirements, and length of stay. During the review, 52 control (non-TXA) and 43 study (TXA) patients were identified as meeting inclusion criteria. Patients in the control group were found to be less acute, which correlated with shorter hospitals stays. There was reduced mortality for patients receiving TXA in spite of their increased acuity and decreased likelihood of survival. Trauma patients from this cohort study receiving TXA demonstrate decreased mortality in spite of increased acuity. This increased acuity is associated with increased transfusion requirements. Future research should evaluate patient selection with concern for fibrinolysis and provider bias. Randomized controlled trial is needed to evaluate the role of TXA administration in the United States.

Department of Anesthesia, Ochsner LSU Health Shreveport, Louisiana (Dr Brian Cornelius); Departments of Emergency Medicine (Dr Moody and Angela Cornelius) and Anesthesia (Dr Hopper), Louisiana State University Health Sciences Center, Shreveport; and Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University, Shreveport (Mr Kilgore and Drs Cvek and Trutschl).

Correspondence: Brian Cornelius, DNP, CRNA, NRP, Department of Anesthesia, Ochsner LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103 (brian.cornelius@ochsnerlsuhs.org).

The author contributions are as follows: Brian Cornelius: responsible for research coordination, analysis, and manuscript preparation; Kelsey Moody, Katelyn Hopper, and Angela P. Cornelius: responsible for data collection, analysis, and manuscript preparation; and Phillip Kilgore, Urska Cvek, and Marjan Trutschl: responsible for data analysis and manuscript preparation.

The authors declare no conflicts of interest.

Copyright © 2019 by the Society of Trauma Nurses.