Antifibrinolytic treatment of trauma patients
Background: The Ben Taub General Hospital (BTGH) is one of the largest level I trauma centers in the nation. In September 2009, a massive transfusion protocol (MTP) was put into place at BTGH. This is important because patients with severe trauma may have trouble clotting and require replenishment of their clotting factors. However a small subset of these patients will dissolve their own clots in a process called fibrinolysis. They will not recover unless the fibrinolysis is stopped. In July 2012, the BTGH trauma team established a policy of initial administration of tranexamic acid (TXA) as part of the MTP to prevent these patients from developing fibrinolysis. This study examines the association of the TXA policy on survival among these patients. Study Design and Methods: Chart review was performed on the 315 patients for whom an MTP was activated between September 2009 and April 2013. This study included all trauma MTP cases during this time for which at least one TEG was available. When more than one TEG was available, the TEG with greatest fibrinolysis level was selected. Other data collected included demographic and anthropometric variables, injury and treatment data, neurological status, and survival status. Logistic regression of 30-day survival outcome with TXA policy as exposure was performed. Potential confounders and effect modifiers were investigated. Results: Of the 315 activated MTPs, 238 were for trauma, (127 penetrating and 111 blunt). Of these, 196 had TEG data available and formed the study group. This consisted of 64 “after” patients (arriving after the TXA policy was initiated) and 132 “before” patients (arriving before the TXA policy). Other than age, there were no significant differences between the before and after groups. The mean age of the before and after groups were 42 and 35 years respectively (p<0.01). The survival rate for the before group and after groups was 58% and 75% respectively (p=0.02). The mean fibrinolysis level for the before and after groups was 10.1% and 5.3% respectively (p=0.03). Logistic regression of 30-day survival showed a crude odds ratio of 2.03, 95% CI = (1.07, 3.99), p = .03 for survival due from the TXA policy to prior to the policy. Age and GCS were considered confounders and when adjusted for age and GCS, the odds ratio was 2.46 (1.23, 5.13), p < 0.01. Conclusion: Despite being a retrospective study, these data support a policy of administering tranexamic acid as the first step of an MTP for trauma patients.
Franco, Zachary, "Antifibrinolytic treatment of trauma patients" (2013). Texas Medical Center Dissertations (via ProQuest). AAI1552463.