Administration of tranexamic acid in trauma patients under stricter inclusion criteria increases the treatment window for stabilization from 24 to 48 hours-a retrospective review.

BACKGROUND: Since 2010, the use of Tranexamic Acid (TXA) in trauma has been brought to the forefront of severe hemorrhage treatment. However, the mixed literature illustrates the need for additional proof of efficacy and determining which patients may benefit from TXA. The purpose of this retrospective study was to evaluate a more stringent TXA inclusion criterion (heart rate ≥ 120 beats per minute (BPM) with a systolic blood pressure (SBP) ≤ 90 mmHg) as compared to the standard CRASH-2 inclusion criteria.

METHODS: From 2013-2016 a total of 115 patients (control, n = 62; TXA, n = 53) were included in the analysis. These patients adhered to the standard CRASH-2 and more stringent inclusion criteria; they also survived at least 8.5 hrs (minimum amount of time required for full TXA dose) from the initiation. Basic characteristics of the patients were summarized. The mortality rates between TXA and control groups were compared using two proportion z-tests. All p values <0.05 were considered statistically significant.

RESULTS: There was no statistical significant difference in patient characteristics between the two treatment groups, making them more comparable ( p value >0.05). This study found a significant reduction of percent mortality at the 24 hr time point against the control ( p = 0.007). Additionally, utilizing the more strict inclusion criteria (BPM ≥ 120 and SBP ≤ 90) substantially extended time to stabilize patients to 48 hrs ( p = 0.029).

CONCLUSION: By imposing the more strict criteria, TXA appears to be a better treatment option in reducing mortality rates and potentially extends the treatment time-frame for stabilizing the patient up to 48 hours.