Early Prehospital Tranexamic Acid Following Injury Is Associated With a 30-day Survival Benefit A Secondary Analysis of a Randomized Clinical Trial

被引:35
作者
Li, Shimena R. [1 ]
Guyette, Francis [2 ]
Brown, Joshua [1 ,3 ]
Zenati, Mazen [1 ,3 ]
Reitz, Katherine M. [1 ]
Eastridge, Brian [4 ]
Nirula, Raminder [5 ]
Vercruysse, Gary A. [6 ]
O'Keeffe, Terence [6 ]
Joseph, Bellal [6 ]
Neal, Matthew D. [1 ,3 ]
Zuckerbraun, Brian S. [1 ,3 ]
Sperry, Jason L. [1 ,3 ]
机构
[1] Univ Pittsburgh, Dept Surg, Pittsburgh, PA 15260 USA
[2] Univ Pittsburgh, Dept Emergency Med, Pittsburgh, PA USA
[3] Univ Pittsburgh, Div Trauma & Gen Surg, Pittsburgh Trauma Res Ctr, Pittsburgh, PA 15260 USA
[4] Univ Texas Hlth San Antonio, Dept Surg, San Antonio, TX USA
[5] Univ Utah, Dept Surg, Salt Lake City, UT USA
[6] Univ Arizona, Dept Surg, Tucson, AZ USA
关键词
hemorrhagic shock; prehospital; tranexamic acid; trauma; MULTIPLE ORGAN FAILURE; TRAUMATIC BRAIN-INJURY; EARLY COAGULOPATHY; SHOCK INDEX; MORTALITY; RESUSCITATION; TRANSFUSION; HEMORRHAGE; CRASH-2; PLASMA;
D O I
10.1097/SLA.0000000000005002
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: We sought to characterize the timing of administration of prehospital tranexamic acid (TXA) and associated outcome benefits. Background: TXA has been shown to be safe in the prehospital setting post-injury. Methods: We performed a secondary analysis of a recent prehospital randomized TXA clinical trial in injured patients. Those who received prehospital TXA within 1 hour (EARLY) from time of injury were compared to those who received prehospital TXA beyond 1 hour (DELAYED). We included patients with a shock index of >0.9. Primary outcome was 30-day mortality. Kaplan-Meier and Cox Hazard regression were utilized to characterize mortality relationships. Results: EARLY and DELAYED patients had similar demographics, injury characteristics, and shock severity but DELAYED patients had greater prehospital resuscitation requirements and longer prehospital times. Stratified Kaplan-Meier analysis demonstrated significant separation for EARLY patients (N = 238, log-rank chi-square test, 4.99; P = 0.03) with no separation for DELAYED patients (N = 238, log-rank chi-square test, 0.04; P = 0.83). Stratified Cox Hazard regression verified, after controlling for confounders, that EARLY TXA was associated with a 65% lower independent hazard for 30-day mortality [hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.19-0.65, P = 0.001] with no independent survival benefit found in DELAYED patients (HR 1.00, 95% CI 0.63-1.60, P = 0.999). EARLY TXA patients had lower incidence of multiple organ failure and 6-hour and 24-hour transfusion requirements compared to placebo. Conclusions: Administration of prehospital TXA within 1 hour from injury in patients at risk of hemorrhage is associated with 30-day survival benefit, lower incidence of multiple organ failure, and lower transfusion requirements.
引用
收藏
页码:419 / 426
页数:8
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