Tranexamic acid for major trauma patients in Ireland

Kieran Walsh; Francis O'Keeffe; Louise Brent; Biswadev Mitra

doi:10.5847/wjem.j.1920-8642.2022.003

Tranexamic acid for major trauma patients in Ireland

World J Emerg Med. 2022;13(1):11-17. doi: 10.5847/wjem.j.1920-8642.2022.003.

Authors

Kieran Walsh^{1

2

3}, Francis O'Keeffe^{1

4}, Louise Brent⁵, Biswadev Mitra^{1

2

3}

Affiliations

¹ National Trauma Research Institute, the Alfred Hospital, Melbourne 3004, Australia.
² Critical Care Research, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia.
³ Emergency & Trauma Centre, Alfred Health, Melbourne 3004, Australia.
⁴ Emergency Department, Mater Misericordiae University Hospital, Dublin D07 R2WY, Ireland.
⁵ National Office for Clinical Audit, Ardilaun House, Dublin D02 VN51, Ireland.

Abstract

Background: The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2 (CRASH-2) is the largest randomized control trial (RCT) examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid (TXA) within 3 hours of injury. Since the publication of CRASH-2, significant geographical variance in the use of TXA for trauma patients exists. This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2.

Methods: A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network (TARN). All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation (as defined by systolic blood pressure [SBP] <100 mmHg [1 mmHg=0.133 kPa] and administration of blood products) were eligible for inclusion. Death at hospital discharge was the primary outcome.

Results: During the study period, a total of 234 patients met the inclusion criteria. Among injured patients presenting with hemorrhagic shock, 133 (56.8%; 95% confidence interval [CI] 50.2%-63.3%) received TXA. Of patients that received TXA, a higher proportion of patients presented with shock index >1 (70.68% vs.57.43%) and higher Injury Severity Score (ISS >25; 49.62% vs. 23.76%). Administration of TXA was not associated with mortality at hospital discharge (odds ratio [OR] 0.86, 95% CI 0.31-2.38).

Conclusions: Among injured Irish patients presenting with hemorrhagic shock, TXA was administered to 56.8% of patients. Patients administered with TXA were on average more severely injured. However, a mortality benefit could not be demonstrated.

Keywords: Hemorrhage; Ireland; Shock; Tranexamic acid.