The use of Tranexamic acid in trauma patients with hemorrhagic shock - a retrospective study in a tertiary care hospital.

Abstract

Introduction - Hemorrhagic shock is the major complication and cause of morbi-mortality in trauma patients. We aimed to study the impact of tranexamic acid in trauma patients with hemorrhagic shock in a tertiary hospital. Material and methods - Our study, performed at Centro Hospitalar e Universitário São João, included adult trauma patients with hemorrhagic shock admitted to the Intensive Care Department. We defined hemorrhagic shock as Systolic Blood Pressure ≤90 mmHg and/or Heat Rate ≥110 bpm. In the absence of these, the clinical judgment of the attending physician prevailed. We did patients cohort with and without tranexamic acid use: we assessed global mortality, invasive mechanical ventilation duration, Intensive Care Unit and hospital length of stay, red blood cells units transfused and vascular occlusive events. Results - 105 patients were included from the 1045 admitted for trauma between January 2017 and December 2018: of those, 38 received tranexamic acid (36,2%) versus 67 without it (63,8%). Tranexamic acid group registered a higher severity (APACHE II p=0,038) and mortality in the Intensive Care Unit either in the global population (p=0,003) or in the stratified Traumatic Brain Injury subgroup (p=0,037). We found no statistically significant differences in the secondary outcomes. Discussion - Trauma patients with hemorrhagic shock admitted in the Intensive Care Department and treated with tranexamic acid had higher mortality, probably explained by the higher severity observed. We didnt find increased vascular occlusive events in tranexamic acid group. Conclusions - It is necessary to complement these findings with more studies and larger cohorts to assess the real benefits of tranexamic acid use in these patients.