Tranexamic acid and trauma

Gruen, Russell L; Jacobs, Ian G; Reade, Michael C

doi:10.5694/mja13.00023

Topics

In reply: We agree with Jarman and Brier that there is safety evidence for tranexamic acid (TxA) in elective surgery. We hypothesise that TxA’s effects in trauma are different. At least 1.5%–2% of trauma patients develop deep vein thrombosis (DVT) and pulmonary embolism (PE), and those who do average twice as long in hospital, are twice as likely to die, and face the long-term risks of anticoagulation and vena-caval filters.1,2 TxA impairs clot breakdown, so could cause excess PEs and DVTs in this higher-risk population, as seen in the MATTERs study.

1 The Alfred Hospital and Monash University, Melbourne, VIC.
2 National Trauma Research Institute, Melbourne, VIC.
3 Emergency Medicine, University of Western Australia, Perth, WA.
4 St John Ambulance (Western Australia), Perth, WA.
5 Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD.
6 Joint Health Command, Australian Defence Force, Canberra, ACT.

Correspondence: R.Gruen@alfred.org.au

Acknowledgements:

Russell Gruen is supported by a National Health and Medical Research Council Practitioner Fellowship.

Competing interests:

All three authors are chief investigators on the NHMRC-funded Prehospital Antifibrinolytics in Traumatic Coagulopathy and Haemorrhage (PATCH-Trauma) Study.

1. Paffrath T, Wafaisade A, Lefering R, et al; Trauma Registry of DGU. Venous thromboembolism after severe trauma: incidence, risk factors and outcome. Injury 2010; 41: 97-101.
2. Knudson MM, Gomez D, Haas B, et al. Three thousand seven hundred thirty-eight posttraumatic pulmonary emboli: a new look at an old disease. Ann Surg 2011; 254: 625-632.
3. United Nations Development Programme. Human Development Report 2009. Overcoming barriers: human mobility and development. New York: Palgrave Macmillan, 2009. http://hdr.undp.org/sites/default/files/reports/269/hdr_2009_en_complete.pdf (accessed Nov 2013).
4. Department of Health. Victorian State Trauma Registry: 1 July 2011 to 30 June 2012 summary report. Victorian Government, 2013. http://docs.health.vic.gov.au/docs/doc/8622FC45F538C364CA257B6E00178CBE/$FILE/1303020%20VST%20report_web3.pdf (accessed Nov 2013).
5. Gruen RL, Gabbe BJ, Stelfox HT, Cameron PA. Indicators of the quality of trauma care and the performance of trauma systems. Br J Surg 2012; 99 Suppl 1: 97-104.
6. Yutthakasemsunt S, Kittiwattanagul W, Piyavechvirat P, et al. Tranexamic acid for preventing progressive intracranial hemorrhage in adults with traumatic brain injury: a preliminary report [abstract]. In: Abstracts. 28th Annual Meeting National Neurotrauma Symposium; 2010 Jun 14–17; Las Vegas, Nevada. J Neurotrauma 2010; 27: A1-A97.
7. Roberts I. Do animal experiments inform patient care [video]? International Symposium on Systematic Reviews in Laboratory Animal Science. http://www.youtube.com/watch?v=S5gJRRLWLKU (accessed Nov 2013).
8. Haut ER, Chang DC, Pierce CA, et al. Predictors of posttraumatic deep vein thrombosis (DVT): hospital practice versus patient factors - an analysis of the National Trauma Data Bank (NTDB). J Trauma 2009; 66: 994-999.

Online responses are no longer available. Please refer to our instructions for authors page for more information.