Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study

Morrison, Jonathan J., Dubose, Joseph J., Rasmussen, Todd E. and Midwinter, Mark J. (2012) Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Archives of Surgery, 147 2: 113-119. doi:10.1001/archsurg.2011.287

Author Morrison, Jonathan J.
Dubose, Joseph J.
Rasmussen, Todd E.
Midwinter, Mark J.
Title Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study
Journal name Archives of Surgery   Check publisher's open access policy
ISSN 0004-0010
Publication date 2012-01-01
Year available 2012
Sub-type Article (original research)
DOI 10.1001/archsurg.2011.287
Open Access Status Not yet assessed
Volume 147
Issue 2
Start page 113
End page 119
Total pages 7
Place of publication Chicago, IL United States
Publisher American Medical Association
Language eng
Formatted abstract
Objectives To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality.

Design Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival.

Setting A Role 3 Echelon surgical hospital in southern Afghanistan.

Patients A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries.

Main Outcome
Measures Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications.

Results The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P < .001). This benefit was greatest in the group of patients who received massive transfusion (14.4% vs 28.1%, respectively; P = .004), where TXA was also independently associated with survival (odds ratio = 7.228; 95% CI, 3.016-17.322) and less coagulopathy (P = .003).

Conclusions The use of TXA with blood component–based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
Keyword Surgery
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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