Trauma patients with admission hyperfibrinolysis: no lasting TXA benefit

  • Khan M & al.
  • J Trauma Acute Care Surg
  • 1 Nov 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients with trauma-related hemorrhage and hyperfibrinolysis upon admission, tranexamic acid (TXA) was not associated with better survival after the first 6 hours.
  • Editorial calls for prospective randomized trials.

Why this matters

  • Hyperfibrinolysis contributes to trauma coagulopathy and has been linked to mortality.
  • TXA prevents fibrinolysis.
  • CRASH-2 suggested TXA benefit in trauma patients, but had important limitations.

Key results

  • With vs without TXA:
    • 6-hour mortality: 16% vs 34% (P=.04);
    • 24-hour plasma transfusion requirement: 15 vs 10 units (P=.03).
  • No between-group difference in 12- or 24-hour or 30-day mortality, red blood cell or platelet transfusions, time to hemostasis, rebleeding, deep venous thrombosis, pulmonary embolism, cause of death.
  • TXA group had more acute kidney injury, systemic inflammatory response syndrome, sepsis, multisystem organ failure.

Study design

  • Secondary analysis of Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial (n=680).
  • Researchers examined 118 patients with admission hyperfibrinolysis on thromboelastography.
  • Using propensity matching, they compared those who did (n=31) and did not (n=62) receive TXA (at provider discretion).
  • Outcome: mortality, transfusion, time to hemostasis, rebleeding after hemostasis. 
  • Funding: None disclosed; PROPPR supported by US, Canadian federal and defense funds.

Limitations

  • Small, retrospective, nonrandomized; risk for bias, confounding. 

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