Guidance Document for the Prehospital Use of Tranexamic Acid in Injured Patients

Fischer, Peter; Bulger, Eileen M.; Perina, Debra G.; Delbridge, Theodore R.; Gestring, Mark L.; Fallat, Mary E.; Shatz, David V.; Doucet, Jay; Levy, Michael; Stuke, Lance; Zietlow, Scott P.; Goodloe, Jeffrey M.; VanderKolk, Wayne E.; Fox, Adam D.; Sanddal, Nels D.

doi:10.3109/10903127.2016.1142628

Cited by 26 publications

(23 citation statements)

References 8 publications

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“…14 Many of the recent studies related to prehospital care of traumatic hemorrhage focus on the resuscitation product. 15–18 In addition to these efforts, given our experience in the assessment of PHPs, it is necessary to continue to develop and to validate improved training methods and simulation models.…”

Section: Discussionmentioning

confidence: 99%

Assessment of prehospital hemorrhage and airway care using a simulation model

Skube

Witthuhn

Mulier

et al. 2018

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 99%

Assessment of prehospital hemorrhage and airway care using a simulation model

Skube

Witthuhn

Mulier

et al. 2018

J Trauma Acute Care Surg

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“…Stock levels and administration equipment should be relatively straight forward to address. Substantial prehospital delays to definitive care might suggest that the initial TXA dose be licensed for use by appropriate prehospital providers, as is done elsewhere [16] . Improved record keeping would also go a long way to improve data capture and thus quality of retrospective research.…”

Section: Discussionmentioning

confidence: 99%

Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital

Wiese

Hoving

Hunter

et al. 2017

African Journal of Emergency Medicine

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IntroductionIn South Africa’s high injury prevalent setting, it is imperative that injury mortality is kept to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance.MethodsA retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was done. A sample of 301 patients was randomly selected from Khayelitsha’s resuscitation database and data were supplemented through chart review. The primary endpoint was compliance with local guidance: systolic blood pressure <90 or heart rate >110 or a significant risk of haemorrhage. Injury Severity Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and ISS <8 as low risk. Linear regression and Fischer’s Exact test were used to explore assumptions.ResultsOverall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none received a follow-up infusion. Compliance with the protocol was significantly better if an indication for TXA did not exist, compared to when one did (p < 0.001). Increased TXA use was associated only with ISS >15 (p < 0.001).DiscussionTXA is not used in accordance with local guidelines. It was as likely not to be used when indicated than when not indicated. Reasons for this are multifactorial and likely include stock levels, lack of administration equipment, time to reach definitive care, poor documentation and hesitancy to use. Further investigation is needed to understand the barriers to administration.

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“…El primero es el estudio más referenciado sobre el ATX y la homeostasis. Este ensayo clínico se realizó en 20,211 pacientes en 40 países, donde se observó que el riesgo de mortalidad disminuyó en un 1.5% y la muerte causada por choque hipovolémico se redujo en un 0.8%; todos los pacientes recibieron ATX en una dosis de 1 gramo inicial y 1 gramo en las siguientes horas 30,31 . El segundo Figura 1.…”

Section: El áCido Tranexámico En Ensayos Clínicos Prehospitalariosunclassified

Ácido tranexámico en la medicina prehospitalaria en México

Pingarrón-Ríos¹,

Jiménez-Flores²,

Soriano-Palomino³

et al. 2021

REIE

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El ácido tranexámico se administra usualmente a escala mundial en las hemorragias masivas. Recientemente se describe su aplicación en distintas especialidades de manera más frecuente, incluyendo la medicina prehospitalaria. En México no se utiliza este medicamento de manera habitual en dicho ámbito pese a que el trauma y la hemorragia son algunas de las principales causas de muerte en la población joven. El propósito del presente artículo es fundamentar con la evidencia existente por qué se deberá considerar el uso de este medicamento en México de forma prehospitalaria.

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Guidance Document for the Prehospital Use of Tranexamic Acid in Injured Patients

Cited by 26 publications

References 8 publications

Assessment of prehospital hemorrhage and airway care using a simulation model

Assessment of prehospital hemorrhage and airway care using a simulation model

Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital

Ácido tranexámico en la medicina prehospitalaria en México

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