Abstract
Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study
This retrospective observational study assessed the effect of tranexamic acid (TXA) in combat injury on total blood product use, thromboembolic complications, and mortality. Tranexamic acid is a lysine analog that inhibits fibrinolysis and was shown to reduce mortality after civilian trauma in the CRASH-2 trial (Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage). 1 The MATTERs study reviewed 896 admissions due to combat injuries in Afghanistan that required at least 1 unit of packed red blood cells and was further subdivided into a massive transfusion cohort requiring 10 or more units of packed red blood cells within 24 hours. A total of 293 patients (32.7%) received TXA within 1 hour of injury. Outcome measures were mortality, postoperative coagulopathy, and thromboembolic complications.
Administration of TXA had an absolute reduction for 30-day mortality of 6.5% (P < .3) in the overall cohort and 13.7% (P < .004) in the massive transfusion cohort. Collectively, the TXA group had a higher injury severity score, greater transfusion requirements, and higher rates of thromboembolic complications; however, the authors noted that TXA was independently associated with survival (odds ratio 7.228) and less coagulopathy. Overall, the beneficial effect of TXA was much greater in patients with higher injury severity who were receiving massive transfusion. This study is limited by its retrospective design, differences of injury severity between groups, and difficulty following 30-day outcomes for Afghan natives. The authors conclude that TXA should be considered for combat injury patients with hemorrhage requiring extensive blood-product resuscitation to improve coagulopathy and overall survival.
(Arch Surg. 2011 [Epub ahead of print]) JJ Morrison, JJ Dubose, TE Rasmussen, MJ Midwinter
Prepared by Matthew Stewart, MD, University of Utah Emergency Medicine Resident, Salt Lake City, UT, USA.