Effects of Tranexamic Acid on Mortality and Blood Transfusion in Trauma Patients with Significant Hemorrhage: A Clinical Trial

Farzad Kakaei, Peyman Virani, Shahriar Hashemzadeh, Sina Zarrintan, Samad Beheshtirouy, Touraj Asvadi

Abstract


Extensive hemorrhage is a significant cause of mortality in trauma patients. Tranexamic acid has been used for controlling bleeding in cardiovascular surgeries and dental manipulations in patients with hemophilia. However, in traumatic patients with bleeding, its use dates back to more recent years. This study aims to examine the effects of this drug on reducing mortality and blood transfusion rate in trauma patients with significant hemorrhage. A total of 60 patients with significant trauma-related hemorrhage (systolic blood pressure < 90 mmHg/heart rate > 110/min) from the emergency department of Imam Reza Hospital (Tabriz, Iran), were randomized in two groups. The case group received intravenous Tranexamic acid (1 g in 10 min and then 1 g over 8 h). The control group received placebo. Rate of transfusion and rate of one-month mortality were compared between the study groups. The mean ICU stay and overall hospitalization times did not have significant difference between two groups (p<0.05). Transfusion of packed cells was 6.03±1.50 and 6.03±1.22 units in case and control groups respectively. Transfusion of fresh frozen plasma (FFP) was 2.50±1.36 and 3.03±0.96 units in case and control groups respectively (p=0.09). Transfusion of platelets was 0.40±0.20 1.33±0.31 units in case and control groups respectively (p=0.01). Three patients (10%) in the case group and 4 patients (13.3%) in the control group were expired (p=0.50). Tranexamic acid is safe and effective in reducing platelet transfusion rate in patients with trauma-related significant hemorrhage. However, transfusion need and mortality would not reduce by its use in trauma patients.

 


Keywords


Trauma; Hemorrhagic shock; Tranexamic Acid; Transfusion

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References


Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. (1995). Epidemiology of trauma deaths: a reassessment. J Trauma, 38(2), 185-193.

Lawson JH, Murphy MP. (2004). Challenges for providing effective hemostasis in surgery and trauma. Semin Hematol, 41(1 Suppl 1), 55-64.

Porte RJ, Leebeek FW. (2002). Pharmacological strategies to decrease transfusion requirements in patients undergoing surgery. Drugs, 62(15), 2193-2211.

Porte RJ, Molenaar IQ, Begliomini B, Groenland TH, Januszkiewicz A, Lindgren L, et al. (2000). Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study. EMSALT Study Group. Lancet, 355(9212), 1303-1309.

Henry DA, Moxey AJ, Carless PA, O'Connell D, McClelland B, Henderson KM, et al. (2001). Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev, (1), CD001886.

Roberts I, Shakur H, Ker K, Coats T, collaborators C-T. (2012). Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev, 12CD004896.

Williams-Johnson JA, McDonald AH, Strachan GG, Williams EW. (2010). Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) A randomised, placebo-controlled trial. West Indian Med J, 59(6), 612-624.

Sorensen B, Fries D. (2012). Emerging treatment strategies for traumainduced coagulopathy. Br J Surg, 99 Suppl 140-50.

Pusateri AE, Weiskopf RB, Bebarta V, Butler F, Cestero RF, Chaudry IH, et al. (2013). ranexamic acid and trauma: current status and knowledge gaps with recommended research priorities. Shock, 39(2), 121-126.

Kauvar DS, Wade CE. (2005). The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care, 9 Suppl 5S1-9.

Etxaniz A, Pita E. (2016). Management of bleeding and coagulopathy following major trauma. Rev Esp Anestesiol Reanim, 63(5), 289-296.

Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, et al. (2011). Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev, (3), CD001886.

Kenet G, Walden R, Eldad A, Martinowitz U. (1999). Treatment of traumatic bleeding with recombinant factor VIIa. Lancet, 354(9193), 1879.

Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, Rossaint R, et al. (2005). Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebocontrolled, double-blind clinical trials. J Trauma, 59(1), 8-15; discussion 15-18.

Fox CJ, Mehta SG, Cox ED, Kragh JF, Jr., Salinas J, Holcomb JB. (2009). Effect of recombinant factor VIIa as an adjunctive therapy in damage control for wartime vascular injuries: a case control study. J Trauma, 66(4 Suppl), S112-119.

collaborators C-t, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. (2010). Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet, 376(9734), 23-32.

Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. (2012). Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg, 147(2), 113-119.

Brohi K, Cohen MJ, Davenport RA. (2007). Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care, 13(6), 680-685.

Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. (2008). Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J trauma, 64(5), 1211-1217; discussion 1217.

Lapostolle F, Sebbah JL, Couvreur J, Koch FX, Savary D, Tazarourte K, et al. (2012). Risk factors for onset of hypothermia in trauma victims: the HypoTraum study. Crit Care, 16(4), R142.

Levy JH. (2006). Massive transfusion coagulopathy. Semin Hematol, 43(1 Suppl 1), S59-63.

Bailey AM, Baker SN, Weant KA. (2014). Tranexamic Acid for Trauma-Related Hemorrhage. Advanced Emergency Nursing Journal, 36(2), 123-131.

Cervia JS, Sowemimo-Coker SO, Ortolano GA, Wilkins K, Schaffer J, Wortham ST. (2006). An overview of prion biology and the role of blood filtration in reducing the risk of transfusion-ransmitted variant Creutzfeldt-Jakob disease. Transfus Med Rev, 20(3), 190-206.

Cap AP, Baer DG, Orman JA, Aden J, Ryan K, Blackbourne LH. (2011). Tranexamic acid for trauma patients: a critical review of the literature. J Trauma, 71(1 Suppl), S9-14.

Kluger R, Olive DJ, Stewart AB, Blyth CM. (2003). Epsilon-aminocaproic acid in coronary artery bypass graft surgery: preincision or postheparin? Anesthesiology, 99(6), 1263-1269.

Levi M, Levy JH, Andersen HF, Truloff D. (2010). Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med, 363(19), 1791-1800.

collaborators C-, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, et al. (2011). The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 377(9771), 1096-1101, 1101 e1091-1092.

Ker K, Kiriya J, Perel P, Edwards P, Shakur H, Roberts I. (2012). Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial. BMC Emerg Med, 123.

[No authors listed] (2013). Trauma and severe bleeding. Tranexamic acid within one hour to reduce mortality. Prescrire Int, 22(140), 189-190.

Napolitano LM, Cohen MJ, Cotton BA, Schreiber MA, Moore EE. (2013). Tranexamic acid in trauma: how should we use it? J Trauma Acute Care Surg, 74(6), 1575-1586.

Medcalf RL. (2007). Fibrinolysis, inflammation, and regulation of the plasminogen activating system. J Thromb Haemost, 5 Suppl 1132-142.

Syrovets T, Simmet T. (2004). Novel aspects and new roles for the serine protease plasmin. Cell Mol Life Sci, 61(7-8), 873-885.

Jimenez JJ, Iribarren JL, Lorente L, Rodriguez JM, Hernandez D, Nassar I, et al. (2007). Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care, 11(6), R117.

Jimenez JJ, Iribarren JL, Brouard M, Hernandez D, Palmero S, Jimenez A, et al. (2011). Safety and effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dosedependent, phase IV clinical trial. J Cardiothorac Surg, 6138.

Godier A, Roberts I, Hunt BJ. (2012). Tranexamic acid: less bleeding and less thrombosis? Crit Care, 16(3), 135.

Guerriero C, Cairns J, Perel P, Shakur H, Roberts I, collaborators Ct. (2011). Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS One, 6(5), e18987.

Bailey AM, Baker SN, Weant KA. (2014). Tranexamic acid for traumarelated hemorrhage. Adv Emerg Nurs J, 36(2), 123-131; quiz 132-123.

Roberts I. (2016). Fibrinolytic shutdown: fascinating theory but randomized controlled trial data are needed. Transfusion, 56 Suppl 2S115-118.

Moore EE, Moore HB, Gonzalez E, Chapman MP, Hansen KC, Sauaia A, et al. (2015). Postinjury fibrinolysis shutdown: Rationale for selective tranexamic acid. J Trauma Acute Care Surg, 78(6 Suppl 1), S65-69.

Gando S, Sawamura A, Hayakawa M. (2011). Trauma, shock, and disseminated intravascular coagulation: lessons from the classical literature. Ann Surg, 254(1), 10-19.

Ralley FE. (2015). Tranexamic acid: When is enough (data) enough? Can J Anaesth, 62(11), 1149-1152.

Gerstein NS, Kelly SP, Brierley JK. (2015). Yet Another Tranexamic Acid-Related Thrombotic Complication. J Cardiothorac Vasc Anesth. 30(3):e21-2.

Farrell NM, Wing HA, Burke PA, Huiras P. (2015). Addition of tranexamic acid to a traumatic injury massive transfusion protocol. Am J Health Syst Pharm, 72(12), 1059-1064.




DOI: https://doi.org/10.7575/aiac.abcmed.17.05.04.04

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