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Abstract
Background Studies carried out in the hospital setting have objectivized the benefit of tranexamic acid (TXA).1 Under the hypothesis that this is a time-dependent drug, we want to analyze the effect that a very early (on-scene) administration of the drug has over the survival of the hemorrhagic patient.
Method Cases and controls, analyzing consecutively all patients susceptible of treatment, (hemorrhagic trauma, hemodynamically unstable with evidence of bleeding, whether analytical or image-based) between 2015–2018. Cases: on-scene standard treatment administered. Controls: hospital-treated. All received TXA at varying times. Epidemiological Variables: Age, gender, lesional mechanism, severity scales: Trauma and Injury Severity Score (TRISS), Revised Trauma Score (RTS), and Injury Severity Score (ISS). Exposure variable: Early TXA administration. Dependent variable: Survival after 7 days. Inferential statistical analysis: Relationship between categorical variables by Chi-square. Multi-variate binary logistic regression (MBLR) adjusted for TRISS, RTS and ISS indices. Confidence intervals p<0.05.
Results 171 patients: 103 cases, 68 controls. Mean age: 42.05 years (SD-20.4.) 42.1% (71) deceased before 7 days. There is homogeneity in the severity indices among cases and controls: ISS; 47.5(SD:19.7) vs. 42.8 (21.5) p=0.015, RTS; 4.66(SD-2.06) vs. 4.73(SD-1.53) p=0.808 y TRISS; 63.02(SD-35.7) vs. 60.04(SD-31.6) p=0.572. After adjusting MBLR for ISS, TRISS, and RTS, survival after 7 days was higher in cases than in controls: 66.0% cases (out-of-hospital TXA administration) vs. 45.6% controls, p=0.006. Odds ratio: 2.32 (1.24–4.34.)
Conclusion Early (on-scene) TXA administration is intensely associated with an improvement in survival indices in hemorrhagic patients, which must lead to its procedural on-scene implementation.
Reference
Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. with CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010;376(9734):23–32. doi: 10.
Conflict of interest None.
Funding None.
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