Use of tranexamic acid in major trauma: a sex-disaggregated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials and UK trauma registry (Trauma and Audit Research Network) data

Nutbeam, Tim; Roberts, Ian; Weekes, Lauren; Shakur-Still, Haleema; Brenner, Amy; Ageron, François-Xavier

doi:10.1016/j.bja.2022.03.032

Cited by 31 publications

(31 citation statements)

References 27 publications

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“…The high-risk BATT score (≥ 8) with less than 10% of overtriage may be useful for prehospital activation of MT protocol. There is recent evidence that many patients that could bene t from tranexamic acid treatment are not being treated, in particular older women (32). The use of the BATT score by paramedics could rationalize the use of tranexamic acid and help tackle inequalities (age and gender).…”

Section: Clinical Implicationmentioning

confidence: 99%

Early identification of bleeding in trauma patients: external validation of traumatic bleeding scores in the Swiss Trauma Registry

Costa

Carron

Zingg

et al. 2022

Preprint

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Background: Early identification of bleeding at the scene of an injury is important for triage and timely treatment of injured patients and transport to an appropriate facility. The aim of the study is to compare the performance of different bleeding scores.Methods: We examined data from the Swiss Trauma Registry for the years 2015 to 2019. The Swiss Trauma Registry includes patients with major trauma (injury severity score (ISS) ≥ 16 and/or abbreviated injury scale (AIS) head ≥ 3) admitted to any level one trauma center in Switzerland. We evaluated ABC, TASH, and Shock index (SI), used to predict massive transfusion (MT) and the BATT score, used to predict death from bleeding. We evaluated the scores when used prehospital and in-hospital in terms of discrimination (C-Statistic) and calibration (calibration slope). The outcomes were massive transfusion and death from bleeding.Results: We examined data from 13,222 major trauma patients. There were 1,533 (12%) deaths from any cause, 344 (3%) deaths from bleeding and 128 (1%) patients who received a MT. The BATT score had the highest discrimination for MT (C-statistic: 0.87, 95%CI 0.84-0.90) followed by SI (0.84, 95%CI 0.80-0.88) and ABC (0.82, 95%CI 0.77-0.86). At hospital admission, the BATT score had the highest discrimination for death from bleeding (0.89, 95%CI 0.87-0.90) but the TASH score had the highest discrimination for MT (C-statistic: 0.94, 95%CI 0.92-0.95). Conclusions: The BATT score can be used to estimate the risk of death from bleeding for prehospital treatment decision-making. Others scores predicting MT are not suitable to identify life-threatening bleeding.Trial registration: Clinicaltrials.gov, NCT04561050. Registered 15 September 2020.

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Section: Clinical Implicationmentioning

confidence: 99%

Early identification of bleeding in trauma patients: external validation of traumatic bleeding scores in the Swiss Trauma Registry

Costa

Carron

Zingg

et al. 2022

Preprint

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“…However, differences in mortality after TBI by gender remain inconclusive in the literature. A subanalysis of CRASH-3 study on TBI patients (but with small sample size) showed that females ( n = 21) were receiving less tranexamic acid than males ( n = 91) and the relative risk of death was only significantly better in males [ 38 ]. Therefore, we cannot advocate specific early treatment (i.e., administration of tranexamic acid or hormonal therapy) based only on gender discrepancy until larger multicenter studies addressing the causation and not only the association.…”

Section: Discussionmentioning

confidence: 99%

Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

El‐Menyar

Mekkodathil

Verma

et al. 2022

BioMed Research International

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Objectives. The objective of this study is to explore the gender discrepancy in patients with traumatic brain injury (TBI). Methods. A retrospective analysis of Qatar Trauma Registry (QTR) was conducted among patients (age ≥14y) who were hospitalized with TBI. Data were collected and analyzed based on the gender and age. Results. Over 5 years (2014-2019), 9, 309 trauma patients (90% males and 10% females) were admitted to the trauma center. Of these, 1, 620 (17.4%) patients were hospitalized with TBI (94% males and 6% females). Motor vehicle crash was the main mechanism of injury (MOI) in females, and fall from height was predominant among males. Subdural hematoma (SDH) was the more frequent type of TBI in both genders, but it was more prevalent in male patients ≥55 years. Injury severity score, Glasgow coma scale, and head abbreviated injury score were comparable between males and females. The length of stay in the ICU and hospital and mortality were similar in both genders. However, mortality was higher among males ≥55 years when compared to 14-54 years within the same gender (21% vs. 12%, p = 0.002 ). The crude and adjusted odds ratio did not show that gender is a significant predictor of mortality among TBI patients. Conclusions. Although the incidence and MOI of TBI show significant differences between male and female patients, the severity and outcomes are comparable.

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“…The utility of antifibrinolytics in trauma is defined by the CRASH‐2 trial, 47 and trauma induces a massive fibrinolytic activation, the extent of which relates to the degree of injury; crucially, the benefits of TXA are not restricted to patients with only the more severe injuries, and TXA is effective in minor bleeding across all ages (patients with low baseline risk of death) 122 . Strategies for TXA use need to recognise that women may be less likely to be treated with TXA 123 . The CRASH‐3 trial (subgroup analyses) in adults with TBI (intracranial bleeding on computed tomography [CT] scan, and no major extracranial bleeding), reported that treatment with TXA reduced head injury‐related death in patients with mild‐to‐moderate head injury 49 .…”

Section: Methodsmentioning

confidence: 99%

“…122 Strategies for TXA use need to recognise that women may be less likely to be treated with TXA. 123 The CRASH-3 trial (subgroup analyses) in adults with TBI (intracranial bleeding on computed tomography [CT] scan, and no major extracranial bleeding), reported that treatment with TXA reduced head injury-related death in patients with mildto-moderate head injury. 49 A further RCT evaluated different dosing regimens for pre-hospital TXA in TBI, reporting no overall benefits for functional neurological outcomes at 6 months.…”

Section: Trauma Including Pre-hospital Managementmentioning

confidence: 99%

Haematological management of major haemorrhage: a British Society for Haematology Guideline

et al. 2022

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Use of tranexamic acid in major trauma: a sex-disaggregated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials and UK trauma registry (Trauma and Audit Research Network) data

Cited by 31 publications

References 27 publications

Early identification of bleeding in trauma patients: external validation of traumatic bleeding scores in the Swiss Trauma Registry

Early identification of bleeding in trauma patients: external validation of traumatic bleeding scores in the Swiss Trauma Registry

Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

Haematological management of major haemorrhage: a British Society for Haematology Guideline

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