The Use of Tranexamic Acid in Trauma Patients- a Retrospective Review

Abstract

Background: Hemorrhagic shock is a leading cause of death in traumatically injured patients. Tranexamic acid (TXA) is an inexpensive antifibrinolytic agent that has been shown to decrease mortality in trauma patients. This study evaluated adherence to TXA use recommendations at a level 1 Trauma Centre. Methods: A retrospective cohort study of consecutive trauma patients who received a blood transfusion in the Emergency Department (ED) from Sept 2011 to February 2014 was undertaken. Data was collected from a prospectively collected trauma database, which included demographic information as well as injury characteristics, baseline physiology, coagulation profile, blood product and TXA use. Results: There were 103 patients of whom 87 met a priori criteria for analysis. The mean age was 43.5 years (range 16-92 years). 71.2% were male. TXA was administered in 62.1% (n=54). 18.4% of patients received the full TXA dose (1g initially followed by 1g infusion over 8h) initiated within 3 hours of injury time. Wide variation in practices between speciality care providers was observed. Initiation of a trauma code was a protective factor. Discussion: TXA administration is present at our centre, although overall compliance to the CRASH-2 protocol merits improvement. Reasons for lack of compliance are unclear and require more investigation. Conclusion: Knowledge translation regarding TXA in trauma resuscitation takes time. This study highlights the need for educational interventions to trauma health care providers. Current models of knowledge dissemination may be ineffective and novel methods to do so should be investigated.