Prehospital Tranexamic Acid Administration During Aeromedical Transport After Injury

• Published in: The Journal of surgical research 2019-01, Vol.233, p.132-138
• Main Authors: Boudreau, Ryan M., Deshpande, Keshav K., Day, Gregory M., Hinckley, William R., Harger, Nicole, Pritts, Timothy A., Makley, Amy T., Goodman, Michael D.
• Format: Article
• Language: English
• Subjects: Prehospital care; Tranexamic acid; Trauma; VTE
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2018.07.074

Tranexamic acid (TXA) has been shown to reduce mortality in the treatment of traumatic hemorrhage. This effect seems most profound when given early after injury. We hypothesized that extending a protocol for TXA administration into the prehospital aeromedical setting would improve outcomes while maintaining a similar safety profile to TXA dosed in the emergency department (ED). We identified all trauma patients who received TXA during prehospital aeromedical transport or in the ED at our urban level I trauma center over an 18-mo period. These patients had been selected prospectively for TXA administration using a protocol that selected adult trauma patients with high-risk mechanism and concern for severe hemorrhage to receive TXA. Patient demographics, vital signs, lab values including thromboelastography, blood administration, mortality, and complications were reviewed retrospectively and analyzed. One hundred sixteen patients were identified (62 prehospital versus 54 ED). Prehospital TXA patients were more likely to have sustained blunt injury (76% prehospital versus 46% ED, P = 0.002). There were no differences between groups in injury severity score or initial vital signs. There were no differences in complication rates or mortality. Patients receiving TXA had higher rates of venous thromboembolic events (8.1% in prehospital and 18.5% in ED) than the overall trauma population (2.1%, P