Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: an audit in a major trauma centre in New Zealand.
The New Zealand medical journal · 2018-10-05 · Implementation & quality improvement
Abstract
AIM: To investigate prescribing behaviours around tranexamic acid (TXA) use in the early management of severe trauma, and compare against standards considered to be best practice internationally, as established by the current body of research. METHODS: We undertook a retrospective analysis of all trauma patients requiring massive transfusion protocol (MTP) activation across a 20-month period. A combination of physical and electronic inpatient records and ambulance documentation were reviewed to determine dose and timing of TXA administration. RESULTS: During the period studied, 27 adult trauma patients who required activation of the MTP were identified. Of the patients where TXA was indicated, 76.2% received at least an initial dose of TXA, with 19.0% receiving both doses. 21.1% of patients who received TXA were administered an initial dose within one hour of injury, 52.6% between one and three hours, 26.3% outside three hours. CONCLUSIONS: TXA was found to be under-utilised and significant departures from best practice were found, likely due to persisting uncertainty and unfamiliarity. In particular, delayed administration beyond the three-hour therapeutic window occurred in a quarter of patients, increasing the risk of mortality secondary to haemorrhage. This pattern of use may apply to the wider population of trauma patients in this centre, and requires remedy and reassessment.