References
TXA for HEMS patients with suspected haemorrhage
Abstract
Background:
Tranexamic Acid (TXA) has been shown by the CRASH-2 study to reduce the risk of death by bleeding. This evaluation assesses the use of TXA by the Great North Air Ambulance (GNAAS), and considers the individual patient outcomes in hospital, including the need for blood products and venous thromboembolism (VTE) rate.
Methods:
A service evaluation was performed with the analysis of patient outcome by the review of patient report forms over a 1-year period. Patients who received pre-hospital TXA were identified and further analysis of their outcomes was performed at the two receiving local major trauma centres.
Results:
106 patients received pre-hospital TXA, all within 3 hours. The majority (73%, n=77) had been involved in a road traffic collision. Thirty per cent (n=32) of patients also received a pre-hospital blood transfusion; 73% (n=58) were subsequently shown to have an injury severity score (ISS) ≥15, which traditionally defines major trauma. Six (6.3%) patients were later found to have a VTE (five pulmonary embolism and one deep-vein thrombosis) within 1 month of injury, although no patients died of VTE. Almost half of the patients received an in-hospital transfusion 45% (n= 45).
Conclusion:
TXA is a life-saving drug in the bleeding trauma patient, and within this study population, TXA was administered promptly and appropriately. A VTE incidence of 6.3% is in line with other literature, and there were no recorded deaths from VTE. TXA is available to pre-hospital clinicians across the UK, where the author believes its use should be encouraged.
There are almost 16 000 traumatic deaths worldwide every day (Krug et al. 2000), and it is estimated that up to 40% of trauma deaths are the result of haemorrhage (Kauvar et al. 2006). Tranexamic acid (TXA) is a proven life-saving treatment for trauma patients in the pre-hospital environment, and has been shown by the CRASH-2 study to reduce the risk of death by bleeding if administered within 3 hours, acting by inhibition of fibrinolysis (Shakur et al. 2010). Greatest significance was shown when TXA was administered within 1 hour of injury.
CRASH-2 further found that there was no increase in vascular occlusive events as a result of TXA, and reported an incidence of pulmonary embolism (PE) and deep-vein thrombosis (DVT) post TXA to be 0.7% and 0.4% respectively. There has since been little follow-up regarding the incidence of venous thromboembolism (VTE) post TXA use in the pre-hospital trauma environment.
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed