Issue

Vol 134 No 1532: 26 March 2021

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Issue Summary

Article
SUMMARY

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: a reassessment of prescribing behaviours in a major trauma centre in New Zealand

The use of tranexamic acid (TXA) in the early management of life-threatening bleeding has now been well established, but robust evidence also exists that it may do more harm than good if administered too late, particularly once three hours has elapsed from time of injury. Injury remains one of the most prolific killers of young New Zealanders, largely due to our unenviable road toll, with the South Island in particular having the highest incidence of major trauma in New Zealand, as well as greater distances that must be covered in order to reach hospital. In 2017, a study conducted at Christchurch Hospital found that TXA was underutilised in this cohort of severely injured patients requiring large volumes of transfused blood products, and just over a quarter received it after a delay of more than three hours. In order to ascertain whether utilisation rates had improved, we undertook a retrospective analysis of trauma patients who had required massive transfusion protocol (MTP) activation across a 26-month period, including in that cohort some of those injured in the March 2019 terror attack. During the period studied, 53 trauma patients requiring activation of the MTP were identified, and, of those for whom TXA should have been given, 90.9% received at least one dose, and, of all patients who received TXA, 16.7% received it within one hour of injury, 73.8% between one and three hours and 9.52% outside three hours. These results show that the utilisation of TXA is now more consistent with what is considered best practice, with figures now comparable to those of major trauma centres internationally. Persistent issues include the unrealised potential for much earlier use within the first hour, as has been achieved at centres where pre-hospital administration by ambulance services is the norm.

Article
SUMMARY

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: a reassessment of prescribing behaviours in a major trauma centre in New Zealand

The use of tranexamic acid (TXA) in the early management of life-threatening bleeding has now been well established, but robust evidence also exists that it may do more harm than good if administered too late, particularly once three hours has elapsed from time of injury. Injury remains one of the most prolific killers of young New Zealanders, largely due to our unenviable road toll, with the South Island in particular having the highest incidence of major trauma in New Zealand, as well as greater distances that must be covered in order to reach hospital. In 2017, a study conducted at Christchurch Hospital found that TXA was underutilised in this cohort of severely injured patients requiring large volumes of transfused blood products, and just over a quarter received it after a delay of more than three hours. In order to ascertain whether utilisation rates had improved, we undertook a retrospective analysis of trauma patients who had required massive transfusion protocol (MTP) activation across a 26-month period, including in that cohort some of those injured in the March 2019 terror attack. During the period studied, 53 trauma patients requiring activation of the MTP were identified, and, of those for whom TXA should have been given, 90.9% received at least one dose, and, of all patients who received TXA, 16.7% received it within one hour of injury, 73.8% between one and three hours and 9.52% outside three hours. These results show that the utilisation of TXA is now more consistent with what is considered best practice, with figures now comparable to those of major trauma centres internationally. Persistent issues include the unrealised potential for much earlier use within the first hour, as has been achieved at centres where pre-hospital administration by ambulance services is the norm.