To Tranexamic Acid or Not to Tranexamic Acid? Accuracy of Antifibrinolytic Administration at Altitude

DeVitis, Joseph; Ziegler, Aaron; Barnhart, Chad; Chapman, Alistair J.; Chadwick, Cathryn; Dull, Matthew; Gibson, Charles J.; Koehler, Tracy J.; Davis, Alan T.; Iskander, Gaby; Pounders, Steffen; Krech, Laura; Fisk, Chelsea

doi:10.1016/j.amj.2021.11.009

Cited by 1 publication

(3 citation statements)

References 27 publications

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“…3,4 Our findings are consistent with a study evaluating utilization of TXA in an aeromedical transport system. 15 This study revealed that 43% of patients that received TXA by the aeromedical transport service that serviced a busy level 1 trauma center had no evidence of hemorrhage upon arrival to the hospital, indicating that TXA administration was likely over utilized in their patient population. 15 Further, a review of TXA usage in the prehospital settings revealed at least 30% of patients may have received TXA but had no clear clinical indication for the administration of the medication.…”

Section: Discussionmentioning

confidence: 83%

“…15 This study revealed that 43% of patients that received TXA by the aeromedical transport service that serviced a busy level 1 trauma center had no evidence of hemorrhage upon arrival to the hospital, indicating that TXA administration was likely over utilized in their patient population. 15 Further, a review of TXA usage in the prehospital settings revealed at least 30% of patients may have received TXA but had no clear clinical indication for the administration of the medication. 16 In the uncontrolled environment of the prehospital system, application of protocols is generally pragmatic rather than perfect, which could contribute to some inclusion of patients with SBP just above given cutoffs.…”

Section: Discussionmentioning

confidence: 83%

“…Several studies have previously identified a significant number of cases in which TXA has been administered without a clear clinical indication resulting in attempts to better standardize administration protocols at other facilities. 15,16 This study, designed as a quality improvement project, examines practice, use, and compliance with data-supported indications of TXA administration within multiple EMS systems serving a large level 1 trauma center. We hypothesized that current widespread TXA use often includes administration outside of the physiologic parameters found to yield a mortality benefit within the previously published large multicenter trials.…”

Section: Introductionmentioning

confidence: 99%

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Are Data Driving Our Ambulances? Liberal Use of Tranexamic Acid in the Prehospital Setting

Brito,

Stettler,

Fram

et al. 2023

The American Surgeon™

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Background Current data on tranexamic acid (TXA) supports early administration for severe hemorrhagic shock. Administration by EMS has been facilitated by developing protocols and standing orders informed by these data. In this study, patterns of TXA use by EMS agencies serving a large level 1 trauma center were examined. We hypothesized that current widespread TXA use often includes administration outside of data-driven indications. Methods The trauma registry at a level 1 trauma center was queried for patients who received TXA. To determine the practice patterns and appropriateness of administration of TXA, patients’ physiologic state in the prehospital environment based on EMS records, physiologic state on arrival to hospital, and interventions performed in both settings were examined. Over 20 separately managed EMS systems that administer TXA transport patients to this trauma center, allowing for a broad survey of practices. Results From 2016 to 2021 1089 patients received TXA, 406 (37.3%) having treatment initiated by EMS services. Of these, the average prehospital systolic blood pressure (SBP) was 108.2 mmHg and initial ED SBP was 107.8 mmHg. Only 58.4% of these patients received blood transfusion after arrival to this trauma center. Compliance with standard indications was low with only 14.6% of administrations meeting any data-driven SBP indication. Similar levels of compliance were seen across high volume EMS services. Discussion Tranexamic acid use has become common in trauma and has been adopted by many EMS systems. These results indicate TXA in the prehospital setting is over-used as administration is not being limited to indications that have shown benefit in prior data.

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