Rethinking The Role of Prehospital TXA in Severe Trauma

20 Jun 2023 • Initiated before hospital admission in advanced trauma systems, tranexamic acid provided an early survival benefit that failed to translate into favorable 6-month outcomes in the PATCH-Trauma trial, as per the results published in the New England Journal of Medicine.

  • The study examined the drug tranexamic acid, which is commonly used to limit bleeding during surgery. However, its usefulness in emergency settings as a pre-emptive strike in life-threatening bleeding has been controversial.
  • The Pre-hospital Antifibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH-Trauma) Study was designed to solve this dilemma.
  • It involved 1310 severely injured patients treated by 15 ambulance services and 21 trauma centres in Australia, New Zealand and Germany, taking eight years to complete.
  • Among people with severe trauma at risk for trauma-induced coagulopathy, the odds of survival with a favorable functional outcome at 6 months after injury were 53.7% with early tranexamic acid administration and a near-identical 53.5% with placebo.

What did the PATCH-trial find? Among adults with major trauma who were at risk for trauma-induced coagulopathy and were receiving treatment in advanced trauma systems, 1 g of intravenous tranexamic acid initiated in the prehospital setting followed by an infusion of 1 g of tranexamic acid over a period of 8 hours in the hospital appeared to be associated with lower early mortality but did not result in a higher percentage of patients surviving with a favorable functional outcome at 6 months than placebo.

Source: NEJM | Read full story

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