Page 145 - Journal of Special Operations Medicine - Summer 2016

What Can TCCC Offer to CRASH-2: Timing of TXA
My Civilian EMS System? Dosing – Lancet 2011

• Tourniquets
• Hemostatic dressings
• Trauma airway approach
• TCCC Needle Decompression Plan • Subgroup analysis of 20,211 trauma patients based on
• Tranexamic Acid (TXA) time of administration of TXA
• Hypotensive resuscitation - with blood products where • Timing; only deaths due to bleeding
possible • 3076 overall deaths; 1063 due to bleeding
• Intraosseous vascular access • Risk of death due to bleeding was significantly
reduced (5.3% vs 7.7%) if TXA was given within 1
• Triple-Option Analgesia hour of injury. At 1-3 hrs after injury, also significant
(4.8 vs 6.1%) At times > 3 hrs, mortality increased.

MATTERS Paper Summary TXA
Morrison – Arch Surg - 2011

• 896 consecutive combat casualties: TXA or no-TXA
• First report of TXA use in combat casualties
• TXA group had lower mortality (17.4% vs 23.9%;
P=0.03) despite TXA group being more severely
injured (ISS 25.2 vs 22.5)
• Benefit was greatest in casualties who received a
MT: mortality with TXA was 14.4% vs 28.1 % in
the no-TXA group (p=0.004)
• Both DVT and PE were increased in the TXA group,
(PE in TXA MT group 3.2% vs 0% in no-TXA MT Beyond CRASH-2 and MATTERS
group); no PE fatalities in the study

Karam – TXA in BTKA Huang – TXA Meta-Analysis
J Arthroplasty 2013 J Surg Res 2013

• Simultaneous, bilateral total knee replacements
• Retrospective review; historical controls
• TXA group n= 37; control group n = 50
• IV TXA 20 mg/kg - given BEFORE incision or at time • Results: “A total of 46 randomized controlled trials
of tourniquet release involving 2925 patients were included. The use of TXA
• Transfusion needed post-op: Control 50%; TXA 11% reduced total blood loss by a mean of 408.33 mL….”
• No thromboembolic events in either group

TCCC Updates 131