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Prehospital tranexamic acid shortens the interval to administration by half in Major Trauma Networks: a service evaluation
  1. Max E R Marsden1,2,
  2. Andrea Rossetto2,
  3. Charles A B Duffield1,3,
  4. Thomas G D Woolley1,4,
  5. William P Buxton1,5,
  6. Sarah Steynberg1,6,
  7. Rahul Bagga5,
  8. Nigel R M Tai1,2
  1. 1 Academic Departments of Military Surgery, Trauma and Anaesthesia, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2 Centre for Trauma Sciences, Blizard Institute, Queen Mary, University of London, London, UK
  3. 3 Imperial College Healthcare NHS Trust, St Marys Hospital, London, UK
  4. 4 Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  5. 5 King’s College Hospital NHS Foundation Trust, Kings College Hospital, London, UK
  6. 6 St. George’s University Hospital NHS Foundation Trust, St. George’s Hospital, London, UK
  1. Correspondence to Max E R Marsden, Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham B15 2SQ, UK; drm.marsden{at}


Introduction Tranexamic acid (TXA) reduces bleeding and mortality. Recent trials have demonstrated improved survival with shorter intervals to TXA administration. The aims of this service evaluation were to assess the interval from injury to TXA administration and describe the characteristics of patients who received TXA pre-hospital and in-hospital.

Methods We reviewed Trauma and Audit Research Network records and local trauma registries to identify patients of any age that received TXA at all London Major Trauma Centres and Queen’s Medical Centre, Nottingham, during 2017. We used the 2016 NICE Guidelines (NG39) which state that TXA should be given within 3 hours of injury.

Results We identified 1018 patients who received TXA, of whom 661 (65%) had sufficient data to assess the time from injury to TXA administration. The median interval was 74 min (IQR: 47–116). 92% of patients received TXA within 3 hours from injury, and 59% within 1 hour. Half of the patients (54%) received prehospital TXA. The median time to TXA administration when given prehospital was 51 min (IQR: 39–72), and 112 min (IQR: 84–160) if given in-hospital (p<0.001). In-hospital TXA patients had less haemodynamic derangement and lower base deficit on admission compared with patients given prehospital TXA.

Conclusion Prehospital administration of TXA is associated with a shorter interval from injury to drug delivery. Identifying a proportion of patients at risk of haemorrhage remains a challenge. However, further reinforcement is needed to empower pre-hospital clinicians to administer TXA to trauma patients without overt signs of shock.

  • trauma centres
  • multiple trauma
  • tranexamic acid
  • haemorrhage
  • fibrinolysis

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  • Contributors MERM and AR collected the data, analysed the data, wrote and edited the manuscript. CABD and TGDW conceived the study and were local leads registering the study and collecting data. WPB and SS were local leads registering the study and collecting data. RB contributed to data collection and manuscript preparation. NRMT edited the manuscript and provided critical review.

  • Funding AR was supported by a scholarship for high-quality postgraduate training from the Fondazione Cassa Rurale di Trento, Italy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.