BuildEXITO: 5RL5GM118963-06, 5TL4GM118965-06, 5RL5GM118963-07, and 5TL4GM118965-07 - Department of Defense (LITES Project): W81XWH-16-D-0024-0001 - OHSU Trauma Research Lab - Portland State University Honors College
Date of Award
Bachelor of Science (B.S.) in Public Health Studies: Pre-clinical Health Science and University Honors
OHSU-PSU School of Public Health
Antifibrinolytic agents -- Therapeutic use, Hemorrhage -- Treatment -- Complications, Thrombelastography, Blood coagulation tests, Trauma centers
Background: Tranexamic acid (TXA) is an antifibrinolytic used for controlling hemorrhaging in patients. It’s regular application in trauma centers could be vital in reducing all-cause mortality for hemorrhaging secondary to traumatic injury but there are still concerns about possible side effects and populations at greater risk of complications. The possible use of predictive measures such as thrombelastography (TEG) and conventional coagulation testing (CCT) in detecting early markers of TXA risks are still unconfirmed, and unfortunately there is a time restriction of 3 hours for TXA to be effective in reducing all-cause mortality.
Objective: Our objective is to observe outcomes of patients who received TXA to see if there were any significant associated thromboembolic complications, and to evaluate TEG and CCT results to find any values that can be used as predictive measures for anticipating these complications in the future. Our ultimate goal is to support the case for TXA to be implemented more frequently in pre-hospital settings to meet the 3-hour administration range.
Methods: This was a retrospective study of trauma patients at the Oregon Health and Science University (OHSU) trauma center. Data was obtained from patients at risk of hemorrhagic shock with an Injury Severity Score (ISS) >9. Patients who received TXA between 2017 and 2019 were crossmatched with patients who did not receive TXA by ISS score. Parametric and non-parametric tests were used to find significance (p-value< 0.05) based on distribution of the data.
Results: Mortality rate in the TXA group was 2.7% lower than the non-TXA group but had a slightly longer hospital length of stay. The TXA group also had a higher rate of penetrating mechanism of injuries which may have been reflected in the higher injury scores in the abdomen and lower extremity, but we did not see an increase in blood products used. There was also a trend toward significance of DVT occurrence in the TXA group. Upon comparison of TEG values, significance (<0.05) was only found in the alpha angle.
Conclusion: Longer hospital length of stay may be due to the high rate of penetrating injuries which would typically require more time to recover due to complications if lacerations were to occur on multiple organs. The higher rate of DVT in TXA may be due to OHSU’s preventative screening of DVTs as opposed to other hospitals which only screen for DVTs if a patient is symptomatic. We were also limited by a small sample size, and only having data from a single hospital. TEG and CCT results contained no predictive indicators of thromboembolic complications, which is most likely due to the machine not being sensitive enough. Overall there is no indication of risk associated with administration of TXA. A larger study would be needed to have more power behind our results to confirm our findings.
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McCorkle, Hunter A., "Outcome Analysis of Tranexamic Acid in Thromboembolic Complications and Coagulation Factors" (2020). University Honors Theses. Paper 976.