The effects of prehospital TXA on mortality and neurologic outcomes in patients with traumatic intracranial hemorrhage: A subgroup analysis from the prehospital TXA for TBI trial

Affiliations

Affiliation

¹ From the Department of Surgery (S.R.), University of Chicago, Section of Trauma and Critical Care, Chicago, Illinois; Department of Biostatistics (E.N.M.), University of Washington, Seattle, Washington; Department of Surgery (T.H.G., M. Fleming), Oregon Health & Science University, Section of Trauma and Acute Care Surgery, Portland, Oregon; Department of Emergency Medicine, Oregon Health & Science University (J.J.), Portland, Oregon; Division of Emergency Medicine, Department of Medicine (L.M.), University of Toronto, Toronto, ON, Canada; Department of Surgery (E.B., B.R.), University of Washington, Seattle, Washington; National Heart, Lung, and Blood Institute (G.S.), National Institutes of Health, Atlanta, Georgia; Johns Hopkins University School of Medicine (M.W.), Baltimore, Maryland; Department of Emergency Medicine (J.C.), University of British Columbia, Vancouver, BC, Canada; Bloodworks Northwest (P.K.), Seattle, Washington; Department of Emergency Medicine (J.M.M.), University of Cincinnati, Cincinnati, Ohio; Kingston Health Sciences Center (J.C.), Kingston, ON, Canada; Department of Biostatistics (K.S.), University of Washington, Seattle, Washington; Trauma Surgery (B.T.), Texas Health Presbyterian Hospital, Dallas, Texas; Department of Emergency Medicine (T.A.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (B.C.), McGovern Medical School, University of Texas Health Science Center, San Antonio; Department of Surgery (R.G.), John Peter Smith Health Network, Fort Worth, Texas; Department of Emergency Medicine (A.I.), Department of Internal Medicine (A.I.), University of Texas Southwestern Medical Center, Dallas, Texas; Department of Emergency Medicine (R.J.F.), Regions Hospital St Paul, Saint Paul, Minnesota; Department of Emergency Medicine (M. Ferrara), Baylor University Medical Center, Dallas, Texas; Department of Emergency Medicine (N.R.), John Peter Smith Health Network, Ft. Worth, Texas; Fred Hutchinson Cancer Center (D.K.), Seattle, Washington; British Columbia Emergency Health Services (R.S.), Victoria, BC, Canada; Department of Surgery (D.D.), Regions Hospital, St. Paul, Minnesota; Department of Emergency Medicine (J.T.), University of British Columbia, Vancouver, BC, Canada; Department of Emergency Medicine (A.H.), Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine (M.G.), Medical City Plano, Plano, Texas; Department of Emergency Medicine (J.G.), Baylor University Medical Center; Emergency Medicine (R.S.), Methodist Dallas Medical Center, Dallas, Texas; Department of Surgery (W.I.MK.), University of Chicago, Chicago, Illinois; and Department of Surgery (M.S.), Oregon Health & Science University, Portland, Oregon.

PMID: 38685481
DOI: 10.1097/TA.0000000000004354

Randomized Controlled Trial

The effects of prehospital TXA on mortality and neurologic outcomes in patients with traumatic intracranial hemorrhage: A subgroup analysis from the prehospital TXA for TBI trial

Susan Rowell et al. J Trauma Acute Care Surg. 2024.

. 2024 Oct 1;97(4):572-580.

doi: 10.1097/TA.0000000000004354. Epub 2024 Apr 30.

Affiliation

¹ From the Department of Surgery (S.R.), University of Chicago, Section of Trauma and Critical Care, Chicago, Illinois; Department of Biostatistics (E.N.M.), University of Washington, Seattle, Washington; Department of Surgery (T.H.G., M. Fleming), Oregon Health & Science University, Section of Trauma and Acute Care Surgery, Portland, Oregon; Department of Emergency Medicine, Oregon Health & Science University (J.J.), Portland, Oregon; Division of Emergency Medicine, Department of Medicine (L.M.), University of Toronto, Toronto, ON, Canada; Department of Surgery (E.B., B.R.), University of Washington, Seattle, Washington; National Heart, Lung, and Blood Institute (G.S.), National Institutes of Health, Atlanta, Georgia; Johns Hopkins University School of Medicine (M.W.), Baltimore, Maryland; Department of Emergency Medicine (J.C.), University of British Columbia, Vancouver, BC, Canada; Bloodworks Northwest (P.K.), Seattle, Washington; Department of Emergency Medicine (J.M.M.), University of Cincinnati, Cincinnati, Ohio; Kingston Health Sciences Center (J.C.), Kingston, ON, Canada; Department of Biostatistics (K.S.), University of Washington, Seattle, Washington; Trauma Surgery (B.T.), Texas Health Presbyterian Hospital, Dallas, Texas; Department of Emergency Medicine (T.A.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (B.C.), McGovern Medical School, University of Texas Health Science Center, San Antonio; Department of Surgery (R.G.), John Peter Smith Health Network, Fort Worth, Texas; Department of Emergency Medicine (A.I.), Department of Internal Medicine (A.I.), University of Texas Southwestern Medical Center, Dallas, Texas; Department of Emergency Medicine (R.J.F.), Regions Hospital St Paul, Saint Paul, Minnesota; Department of Emergency Medicine (M. Ferrara), Baylor University Medical Center, Dallas, Texas; Department of Emergency Medicine (N.R.), John Peter Smith Health Network, Ft. Worth, Texas; Fred Hutchinson Cancer Center (D.K.), Seattle, Washington; British Columbia Emergency Health Services (R.S.), Victoria, BC, Canada; Department of Surgery (D.D.), Regions Hospital, St. Paul, Minnesota; Department of Emergency Medicine (J.T.), University of British Columbia, Vancouver, BC, Canada; Department of Emergency Medicine (A.H.), Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine (M.G.), Medical City Plano, Plano, Texas; Department of Emergency Medicine (J.G.), Baylor University Medical Center; Emergency Medicine (R.S.), Methodist Dallas Medical Center, Dallas, Texas; Department of Surgery (W.I.MK.), University of Chicago, Chicago, Illinois; and Department of Surgery (M.S.), Oregon Health & Science University, Portland, Oregon.

PMID: 38685481
DOI: 10.1097/TA.0000000000004354

Abstract

Background: In the prehospital tranexamic acid (TXA) for traumatic brain injury (TBI) trial, TXA administered within 2 hours of injury in the out-of-hospital setting did not reduce mortality in all patients with moderate/severe traumatic brain injury (TBI). We examined the association between TXA dosing arms, neurologic outcome, and mortality in patients with intracranial hemorrhage (ICH) on computed tomography (CT).

Methods: This was a secondary analysis of the Prehospital Tranexamic Acid for TBI Trial ( ClinicalTrials.gov [NCT01990768]) that randomized adults with moderate/severe TBI (Glasgow Coma Scale score < 13) and systolic blood pressure ≥ 90 mm Hg within 2 hours of injury to a 2-g out-of-hospital TXA bolus followed by an in-hospital saline infusion, a 1-g out-of-hospital TXA bolus/1-g in-hospital TXA infusion, or an out-of-hospital saline bolus/in-hospital saline infusion (placebo). This analysis included the subgroup with ICH on initial CT. Primary outcomes included 28-day mortality, 6-month Glasgow Outcome Scale-Extended (GOSE) ≤ 4, and 6-month Disability Rating Scale (DRS). Outcomes were modeled using linear regression with robust standard errors.

Results: The primary trial included 966 patients. Among 541 participants with ICH, 28-day mortality was lower in the 2-g TXA bolus group (17%) compared with the other two groups (1-g bolus/1-g infusion 26%, placebo 27%). The estimated adjusted difference between the 2-g bolus and placebo groups was -8·5 percentage points (95% confidence interval [CI], -15.9 to -1.0) and between the 2-g bolus and 1-g bolus/1-g infusion groups was -10.2 percentage points (95% CI, -17.6 to -2.9). Disability Rating Scale at 6 months was lower in the 2-g TXA bolus group than the 1-g bolus/1-g infusion (estimated difference - 2.1 [95% CI, -4.2 to -0.02]) and placebo groups (-2.2 [95% CI, -4.3, -0.2]). Six-month GOSE did not differ among groups.

Conclusion: A 2-g out-of-hospital TXA bolus in patients with moderate/severe TBI and ICH resulted in lower 28-day mortality and lower 6-month DRS than placebo and standard TXA dosing.

Level of evidence: Therapeutic/Care Management; Level II.

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References

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The effects of prehospital TXA on mortality and neurologic outcomes in patients with traumatic intracranial hemorrhage: A subgroup analysis from the prehospital TXA for TBI trial

Affiliation

The effects of prehospital TXA on mortality and neurologic outcomes in patients with traumatic intracranial hemorrhage: A subgroup analysis from the prehospital TXA for TBI trial

Authors

Affiliation

Abstract

References

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials