Pre-hospital tranexamic acid administration in patients with a severe hemorrhage: an evaluation after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol

Autor: Max Gulickx, Robin D. Lokerman, Job F. Waalwijk, Bert Dercksen, Karlijn J. P. van Wessem, Rinske M. Tuinema, Luke P. H. Leenen, Mark van Heijl
Přispěvatelé: RS: NUTRIM - R3 - Respiratory & Age-related Health, Surgery, MUMC+: NAZL en ROAZ (9)
Rok vydání: 2023
Předmět:
Zdroj: European Journal of Trauma and Emergency Surgery. Springer
ISSN: 1863-9941
1863-9933
DOI: 10.1007/s00068-023-02262-4
Popis: Purpose To evaluate the pre-hospital administration of tranexamic acid in ambulance-treated trauma patients with a severe hemorrhage after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol. Methods All patients with a severe hemorrhage who were treated and conveyed by EMS professionals between January 2015, and December 2017, to any trauma-receiving emergency department in the eight participating trauma regions in the Netherlands, were included. A severe hemorrhage was defined as extracranial injury with > 20% body volume blood loss, an extremity amputation above the wrist or ankle, or a grade ≥ 4 visceral organ injury. The main outcome was to determine the proportion of patients with a severe hemorrhage who received pre-hospital treatment with tranexamic acid. A Generalized Linear Model (GLM) was performed to investigate the relationship between pre-hospital tranexamic acid treatment and 24 h mortality. Results A total of 477 patients had a severe hemorrhage, of whom 124 patients (26.0%) received tranexamic acid before arriving at the hospital. More than half (58.4%) of the untreated patients were suspected of a severe hemorrhage by EMS professionals. Patients treated with tranexamic acid had a significantly lower risk on 24 h mortality than untreated patients (OR 0.43 [95% CI 0.19–0.97]). Conclusion Approximately a quarter of the patients with a severe hemorrhage received tranexamic acid before arriving at the hospital, while a severe hemorrhage was suspected in more than half of the non-treated patients. Severely hemorrhaging patients treated with tranexamic acid before arrival at the hospital had a lower risk to die within 24 h after injury.
Databáze: OpenAIRE
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