Trauma experts aim to reduce deaths by providing blood-clotting agent

Severely injured trauma patients who received a blood-clotting drug before arriving at the hospital had a better chance of surviving than those who didn’t, according to new research published in Journal of the American Medical Association Surgery.

The multi-center trial, which took place in Pennsylvania, Texas, Utah and Arizona, was designed to determine whether giving tranexamic acid, a blood-clotting agent, to trauma patients before they arrived at the hospital improved patients’ chance of survival. The 903 participants in the study were enrolled from emergency calls where patients were at risk of bleeding from trauma. Half got the tranexamic acid treatment, and half got a saline placebo.

Army Col. Brian Eastridge, MD, professor and chief of the Department of Trauma and Emergency Surgery at UT Health San Antonio and trauma medical director of University Health, led the San Antonio site in the national research study. During the four-year trial period, 86 trauma patients suspected of hemorrhage and transported to University Health participated.

“Prior to the start of the study there was concern from the prehospital provider community regarding the efficacy and safety of tranexamic acid given in the field,” Dr. Eastridge said. Tranexamic acid is commonly used in cardiac surgery to help stop bleeding, but previous studies have suggested that the drug may pose risks, including blood clots and strokes, to patients suffering from severe injuries, he explained.

“This study demonstrated that in the population of injured patients at risk for hemorrhage, tranexamic acid administered before hospitalization did not result in significantly lower mortality of the entire study population. However, it was also noted that the prehospital administration of tranexamic acid did not result in a higher incidence of blood clotting complications or adverse events,” Dr. Eastridge said.

Moreover, in certain subgroups who got the drug within the first hour or who had severe shock when the paramedics arrived, the study found that there was an improvement in survival. This result suggests tranexamic acid may be safer and more beneficial to trauma patients than originally thought.

“The study findings support the development of establishing prehospital tranexamic acid administration protocols,” Dr. Eastridge said, noting that he hopes that these findings will be used to modify guidelines for paramedics.

Additional authors on this research are Francis X. Guyette, MD, Jason Sperry, MD, Joshua B. Brown, MD, MSc, Mazen S. Zenati, MD, PhD, Barbara J. Early-Young, BSN, and Peter W. Adams, BS, all of University of Pittsburgh; Raminder Nirula, MD, MPH, of the University of Utah; Gary A. Vercruysse, MD, of the University of Michigan; Terence O’Keeffe, MD, of the Medical College of Georgia at Augusta University; and Bellal A. Joseph, MD, of the University of Arizona.

This research was funded by U.S. Army Medical Research and Materiel Command grant W81XWH 13-2-0080.

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