Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital (HGH), Doha, Qatar.
Am J Emerg Med. 2020 Feb;38(2):266-271. doi: 10.1016/j.ajem.2019.04.051. Epub 2019 Apr 30.
The purpose of this study was to test the efficacy of prehospital administration of tranexamic acid (TXA) to injured patients on mortality, thromboembolic events and need for blood transfusion in a level 1 trauma center.
We conducted a retrospective study comparing adult trauma patients receiving or not receiving prehospital TXA between January 2017 and September 2018. Patients not receiving TXA but transfused within 4 h of admission were 1:1 matched to TXA-treated patients for age, sex, injury severity score, head abbreviated injury score, prehospital heart rate and systolic blood pressure.
In total 204 patients were included (102 TXA and 102 control), with a mean age of 31 years. On admission, shock index (p = 0.03) and serum lactate (p = 0.001) were greater in the control group, whereas the initial base deficit, hemoglobin levels and EMS time were comparable in both groups. The odd ratio (OR) for shock index ≥0.9 after TXA administration was 0.44 (95% CI 0.23-0.84). The median amount of blood transfusion was greater in the control group [eight units (range 1-40) vs three (range 0-40), p = 0.01] as well as the use of massive blood transfusion [OR 0.35 (95% CI 0.19-0.67)]. In the TXA group, VTE was higher [OR 2.0 (95% CI 0.37-11.40)]; whereas the overall mortality was lower [OR 0.78 (95% CI 0.42-1.45)] without reaching statistical significance.
Prehospital TXA administration is associated with less in-hospital blood transfusion and massive transfusion protocol (MTP). There is no significant increase in the thromboembolic events and mortality, however, further evaluation in larger clinical trials is needed.
本研究旨在检验在一级创伤中心对创伤患者院前给予氨甲环酸（TXA）治疗在死亡率、血栓栓塞事件和输血需求方面的疗效。
我们进行了一项回顾性研究，比较了 2017 年 1 月至 2018 年 9 月期间接受或未接受院前 TXA 治疗的成年创伤患者。对于未接受 TXA 治疗但在入院后 4 小时内输血的患者，我们根据年龄、性别、创伤严重程度评分、头部简明损伤评分、院前心率和收缩压，以 1:1 的比例与 TXA 治疗组患者进行匹配。
共纳入 204 例患者（TXA 组 102 例，对照组 102 例），平均年龄 31 岁。入院时，对照组的休克指数（p=0.03）和血清乳酸（p=0.001）更高，而两组的初始基础缺陷、血红蛋白水平和急救医疗服务时间相当。TXA 治疗后休克指数≥0.9 的比值比（OR）为 0.44（95%CI 0.23-0.84）。对照组的输血中位数[8 单位（范围 1-40）vs 3 单位（范围 0-40），p=0.01]以及大量输血的使用[OR 0.35（95%CI 0.19-0.67）]均大于 TXA 组。TXA 组的静脉血栓栓塞（VTE）发生率较高[OR 2.0（95%CI 0.37-11.40）]；而总体死亡率较低[OR 0.78（95%CI 0.42-1.45）]，但无统计学意义。
院前给予 TXA 与院内输血和大量输血方案（MTP）减少有关。血栓栓塞事件和死亡率没有显著增加，但需要在更大的临床试验中进一步评估。
