Efficacy of prehospital administration of tranexamic acid in trauma patients: A meta-analysis of the randomized controlled trials

被引:29
作者
El-Menyar, Ayman [1 ,2 ]
Sathian, Brijesh [1 ]
Asim, Mohammed [1 ]
Latifi, Rifat [3 ]
Al-Thani, Hassan [4 ]
机构
[1] Hamad Gen Hosp, Dept Surg, Clin Res, Trauma Surg, POB 3050, Doha, Qatar
[2] Weill Cornell Med Sch, Med Clin, Doha, Qatar
[3] Westchester Med Ctr, Dept Surg, Valhalla, NY USA
[4] Hamad Gen Hosp, Dept Surg Trauma & Vasc Surg, Doha, Qatar
关键词
Trauma; Mortality; Thromboembolic event; Tranexamic acid; Pre-hospital; EARLY COAGULOPATHY; INJURY; EPIDEMIOLOGY; MORTALITY; SAFETY;
D O I
10.1016/j.ajem.2018.03.033
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: Antifibrinolytic agent tranexamic acid (TXA) has a potential clinical benefit for in-hospital patients with severe bleeding but its effectiveness in pre-hospital settings remains unclear. We conducted a systematic review andmeta-analysis to evaluatewhether pre-hospital administration of TXA compared to placebo improve patients' outcomes? Methods: PubMed, MEDLINE, Cochrane Library, WHO International Clinical Trials Registry Platform, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, clinicaltrials. gov and Google scholar databases were searched for a retrospective, prospective and randomized (RCT) or quasi-RCT studies that assessed the effect of prehospital administration of TXA versus placebo on the outcomes of trauma patients with significant hemorrhage. Themain outcomes of interestwere 24 hour 30-daymortality and in-hospital thromboembolic complications. Two authors independently abstracted the data using a data collection form. Results from different studies were pooled for the analysis, when appropriate. Results: Out of 92 references identified through the search, two analytical studies met the inclusion criteria. The effect of TXA on 24-hour mortality had a pooled odds ratio (OR) of 0.49 (95% CI 0.28-0.85), 30-day mortality OR of 0.86 (95% CI, 0.56-1.32), and thromboembolic events OR of 0.74 (95% CI, 0.27-2.07). Conclusion: Prehospital TXA appears to reduce early mortality in trauma patients. The pooled analysis also shows a trend toward lower 30-daymortality and reduced risk of thromboembolic events. Additional randomized controlled clinical trials are needed to determine the significance of these trends. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:1079 / 1087
页数:9
相关论文
共 39 条
[11]   The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine [J].
Kunze-Szikszay, Nils ;
Krack, Lennart A. ;
Wildenauer, Pauline ;
Wand, Saskia ;
Heyne, Tim ;
Walliser, Karoline ;
Spering, Christopher ;
Bauer, Martin ;
Quintel, Michael ;
Roessler, Markus .
SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE, 2016, 24
[12]   Tranexamic acid in the prehospital setting: Israel Defense Forces' initial experience [J].
Lipsky, Ari M. ;
Abramovich, Amir ;
Nadler, Roy ;
Feinstein, Uri ;
Shaked, Gadi ;
Kreiss, Yitshak ;
Glassberg, Elon .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2014, 45 (01) :66-70
[13]   Early coagulopathy predicts mortality in trauma [J].
MacLeod, JBA ;
Lynn, M ;
McKenney, MG ;
Cohn, SM ;
Murtha, M .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 55 (01) :39-44
[14]   Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study [J].
Morrison, Jonathan J. ;
Dubose, Joseph J. ;
Rasmussen, Todd E. ;
Midwinter, Mark J. .
ARCHIVES OF SURGERY, 2012, 147 (02) :113-119
[15]   Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery [J].
Movafegh, Ali ;
Eslamian, Laleh ;
Dorabadi, Azita .
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS, 2011, 115 (03) :224-226
[16]  
Mrochuk May, 2015, Air Med J, V34, P37, DOI 10.1016/j.amj.2014.09.004
[17]   Tranexamic acid at the point of injury: The Israeli combined civilian and military experience [J].
Nadler, Roy ;
Gendler, Sami ;
Benov, Avi ;
Strugo, Refael ;
Abramovich, Amir ;
Glassberg, Elon .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2014, 77 :S146-S150
[18]   Tranexamic acid in trauma: How should we use it? [J].
Napolitano, Lena M. ;
Cohen, Mitchell J. ;
Cotton, Bryan A. ;
Schreiber, Martin A. ;
Moore, Ernest E. .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2013, 74 (06) :1575-1586
[19]   Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study [J].
Neeki, Michael M. ;
Dong, Fanglong ;
Toy, Jake ;
Vaezazizi, Reza ;
Powell, Joe ;
Jabourian, Nina ;
Jabourian, Alex ;
Wong, David ;
Vara, Richard ;
Seiler, Kathryn ;
Pennington, Troy W. ;
Powell, Joe ;
Yoshida-McMath, Chris ;
Kissel, Shanna ;
Schulz-Costello, Katharine ;
Mistry, Jamish ;
Surrusco, Matthew S. ;
O'Bosky, Karen R. ;
Van Stralen, Daved ;
Ludi, Daniel ;
Sporer, Karl ;
Benson, Peter ;
Kwong, Eugene ;
Pitts, Richard ;
Culhane, John T. ;
Borger, Rodney .
WESTERN JOURNAL OF EMERGENCY MEDICINE, 2017, 18 (04) :673-683
[20]   Increased mortality associated with the early coagulopathy of trauma in combat casualties [J].
Niles, Sarah E. ;
McLaughlin, Daniel F. ;
Perkins, Jeremy G. ;
Wade, Charles E. ;
Li, Yuanzhang ;
Spinella, Philip C. ;
Holcomb, John B. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2008, 64 (06) :1459-1463