OBJECTIVES: To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. DESIGN: Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival. SETTING: A Role 3 Echelon surgical hospital in southern Afghanistan. PATIENTS: A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries. MAIN OUTCOME MEASURES: Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications. RESULTS: The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P < .001). This benefit was greatest in the group of patients who received massive transfusion (14.4% vs 28.1%, respectively; P = .004), where TXA was also independently associated with survival (odds ratio = 7.228; 95% CI, 3.016-17.322) and less coagulopathy (P = .003). CONCLUSIONS: The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
OBJECTIVES: To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. DESIGN: Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival. SETTING: A Role 3 Echelon surgical hospital in southern Afghanistan. PATIENTS: A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries. MAIN OUTCOME MEASURES: Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications. RESULTS: The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P < .001). This benefit was greatest in the group of patients who received massive transfusion (14.4% vs 28.1%, respectively; P = .004), where TXA was also independently associated with survival (odds ratio = 7.228; 95% CI, 3.016-17.322) and less coagulopathy (P = .003). CONCLUSIONS: The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
Authors: Santiago R Leal-Noval; Manuel Muñoz; Marisol Asuero; Enric Contreras; José A García-Erce; Juan V Llau; Victoria Moral; José A Páramo; Manuel Quintana Journal: Blood Transfus Date: 2013-06-17 Impact factor: 3.443
Authors: Ernest E Moore; Hunter B Moore; Eduardo Gonzalez; Michael P Chapman; Kirk C Hansen; Angela Sauaia; Christopher C Silliman; Anirban Banerjee Journal: J Trauma Acute Care Surg Date: 2015-06 Impact factor: 3.313
Authors: Guojie Wu; Blake A Mazzitelli; Adam J Quek; Matthew J Veldman; Paul J Conroy; Tom T Caradoc-Davies; Lisa M Ooms; Kellie L Tuck; Jonathan G Schoenecker; James C Whisstock; Ruby H P Law Journal: Blood Adv Date: 2019-03-12
Authors: Hunter B Moore; Ernest E Moore; Michael P Chapman; Kirk C Hansen; Mitchell J Cohen; Frederic M Pieracci; James Chandler; Angela Sauaia Journal: J Am Coll Surg Date: 2019-03-29 Impact factor: 6.113
Authors: Donald H Jenkins; Joseph F Rappold; John F Badloe; Olle Berséus; Lorne Blackbourne; Karim H Brohi; Frank K Butler; Andrew P Cap; Mitchell Jay Cohen; Ross Davenport; Marc DePasquale; Heidi Doughty; Elon Glassberg; Tor Hervig; Timothy J Hooper; Rosemary Kozar; Marc Maegele; Ernest E Moore; Alan Murdock; Paul M Ness; Shibani Pati; Todd Rasmussen; Anne Sailliol; Martin A Schreiber; Geir Arne Sunde; Leo M G van de Watering; Kevin R Ward; Richard B Weiskopf; Nathan J White; Geir Strandenes; Philip C Spinella Journal: Shock Date: 2014-05 Impact factor: 3.454