(1748) The Efficacy and Safety of Tranexamic Acid Administered Prehospital for Traumatic Hemorrhage

Introduction: In patients with traumatic hemorrhage, the management of coagulopathy and hyperfibrinolysis is of clinical importance as it has proven to increase the risk of mortality and worse outcomes. Previous studies have demonstrated tranexamic acid (TXA), an antifibrinolytic, has a positive impact on reducing mortality and hematoma size. The 2019 European Task Force for Advanced Bleeding Care in Trauma recommends administration of TXA within three hours of injury in patients with traumatic hemorrhage. However, recent conflicting studies have increased controversy over the efficacy and optimal dosing of TXA.

Methods: This study is a retrospective, single-center chart review conducted at a 700-bed community hospital and level I trauma center. The primary outcome measured is the incidence of 24-hour mortality in patients who received 1g vs 2g total of TXA. Secondary outcomes include in-hospital mortality, length of stay in the intensive care unit, units of blood products received, and requirements for surgical intervention. Additionally, safety will also be evaluated by assessing the rate of vascular occlusive events and neurologic events. The primary outcome will be analyzed using the Fisher’s exact test.

Results: 65 patients met inclusion criteria, with 15 receiving a total of 2g TXA. The difference in 24-hour mortality between groups was not significant (absolute difference 1.33%, p=1.00). There were no significant differences in any secondary outcomes, and the rate of adverse events was similar between groups.

Conclusions: In this single-center, retrospective analysis, a second 1g dose of TXA administered in-hospital was not associated with a significant reduction in 24-hour mortality compared to a single 1g dose of TXA administered pre-arrival.