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Original Article
Antifibrinolytics in a rural trauma state: assessing the opportunities
  1. James M Bardes,
  2. Amanda Palmer,
  3. Jorge Con,
  4. Alison Wilson,
  5. Gregory Schaefer
  1. Division of Trauma, Acute Care Surgery and Critical Care, Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
  1. Correspondence to Dr James M Bardes, West Virginia University, HSC-S, Morgantown, West Virginia, USA; jim.bardes{at}gmail.com

Abstract

Background Tranexamic acid (TXA) has demonstrated improved mortality among trauma patients. However, recent evidence from urban US trauma centers has failed to show a benefit among the civilian population. TXA in rural states has not been evaluated. This study aimed to evaluate the current use of TXA in the rural trauma population.

Methods A retrospective observational review at a level 1 trauma center based in a rural environment. Records were reviewed for TXA indications. TXA indication was defined as: systolic blood pressure <90 mm Hg, blood transfusion, or with a clinical concern for ongoing bleeding. Patients were ineligible if the time since injury was >3 hours.

Results 400 patients were evaluated. 54% of patients met indications for TXA. 14% of these received TXA. 30.4% with an indication for TXA were ineligible due to arrival beyond 3 hours from time of injury. 135 patients arrived as transfers, 265 from the scene. There was no difference in TXA indications between scene and transfers (73 vs 144, p=1). Transfers were more likely to arrive beyond the 3-hour window (59 vs 7, p=0.001). Mortality for patients treated with TXA was 12.5%. This was not significantly different from patients not treated with TXA (19%).

Discussion In a rural system, long transfers exclude most patients from treatment with TXA. A multicenter rural trauma center study will be needed to better define the optimal use of TXA in rural populations.

Level of evidence Level IV data: therapeutic/care management.

  • rural trauma care
  • tranexamic acid

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000107

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    Footnotes

    • Contributors Study design was performed by JMB, AP, GS and AW. Data collection was performed by JMB, AP and JC. The manuscript was written by JMB, JC and GS. All authors participated in critical revisions and resubmission.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.