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Implementation of tranexamic acid for bleeding trauma patients: a longitudinal and cross-sectional study
  1. Timothy J Coats1,
  2. Marisol Fragoso-Iñiguez2,
  3. Ian Roberts3
  1. 1Emergency Medicine, University of Leicester, Leicester, UK
  2. 2Trauma Audit and Research Network (TARN), University of Manchester Institute of Population Health, Manchester, UK
  3. 3Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Timothy J Coats, University of Leicester, Leicester LE1 7RH, UK; tc61{at}le.ac.uk

Abstract

Objective To describe the use of tranexamic acid (TXA) in trauma care in England and Wales since the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial results were published in 2010.

Methods A national longitudinal and cross-sectional study using data collected through the Trauma Audit and Research Network (TARN), the clinical audit of major trauma care for England and Wales. All patients in the TARN database injured in England and Wales were included apart from those with an isolated traumatic brain injury, with a primary outcome of the proportion of patients given TXA and the secondary outcome of time to treatment.

Results Among 228 250 patients, the proportion of trauma patients treated with TXA increased from near zero in 2010 to 10% (4593) in 2016. In 2016, most patients (82%) who received TXA did so within 3 hours of injury, however, only 30% of patients received TXA within an hour of injury. Most (80%) of the patients who had an early blood transfusion were given TXA. Patients treated with TXA by an ambulance paramedic received treatment at a median of 49 min (IQR 33–72) compared with 111 min (IQR 77–162) for patients treated in hospital.

Conclusions There is a low proportion of patients treated with TXA across the range of injury severity and the range of physiological indicators of severity of bleeding. Most patients receive treatment within the existing target of 3 hours from injury, however there remains the potential to further improve major trauma outcomes by the earlier treatment of a wider patient group.

  • trauma, major trauma management
  • haematology

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Footnotes

  • Patient consent for publication Not required.

  • Contributors The article was conceived and initially drafted by TJC and IR. All authors contributed to commenting on drafts of the manuscript and were involved in each stage of planning, interpretation of results and write-up of the work. The statistical analysis was performed by MFI. The final version has been approved by all authors.

  • Funding The Trauma Audit and Research Network (TARN) data collection is funded by the National Health Service of England and Wales through subscriptions from participating hospitals.

  • Competing interests TJC and IR were investigators for the CRASH-2 trial; no other relationships or activities could appear to have influenced the submitted work. TARN is based within a university department and is funded through subscriptions from the hospitals that take part in the audit.

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

  • Data sharing statement Patient-level data are available, subject to a standard data sharing agreement (which can be found at www.tarn.ac.uk), from the corresponding author at tc61@le.ac.uk. Individual participant consent for data sharing was not obtained, but the presented data are grouped and anonymised, risk of identification is low and approval is in place from the UK Department of Health’s Patient Information Advisory Group.

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