Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials
Study objectiveTraumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and potentially enhance outcomes. Previous reviews suggested potential TXA benefits but did not consider the latest trial...
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| مؤلفون آخرون: | , , , , , , |
| التنسيق: | article |
| منشور في: |
2024
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| الموضوعات: | |
| الوصول للمادة أونلاين: | http://dx.doi.org/10.1016/j.annemergmed.2023.10.004 https://www.sciencedirect.com/science/article/pii/S0196064423012817 http://hdl.handle.net/10576/55219 |
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| _version_ | 1857415084317343744 |
|---|---|
| author | Pieter Francsois, Fouche |
| author2 | Stein, Christopher Nichols, Martin Meadley, Benjamin Bendall, Jason C. Smith, Karen Anderson, David Doi, Suhail A. |
| author2_role | author author author author author author author |
| author_facet | Pieter Francsois, Fouche Stein, Christopher Nichols, Martin Meadley, Benjamin Bendall, Jason C. Smith, Karen Anderson, David Doi, Suhail A. |
| author_role | author |
| dc.creator.none.fl_str_mv | Pieter Francsois, Fouche Stein, Christopher Nichols, Martin Meadley, Benjamin Bendall, Jason C. Smith, Karen Anderson, David Doi, Suhail A. |
| dc.date.none.fl_str_mv | 2024-05-20T11:38:12Z 2024-05 |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://dx.doi.org/10.1016/j.annemergmed.2023.10.004 Fouche, P. F., Stein, C., Nichols, M., Meadley, B., Bendall, J. C., Smith, K., ... & Doi, S. A. (2023). Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Annals of Emergency Medicine. 0196-0644 https://www.sciencedirect.com/science/article/pii/S0196064423012817 http://hdl.handle.net/10576/55219 5 83 1097-6760 |
| dc.language.none.fl_str_mv | en |
| dc.publisher.none.fl_str_mv | Elsevier |
| dc.rights.none.fl_str_mv | http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | tranexamic acid emergency treatment |
| dc.title.none.fl_str_mv | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| dc.type.none.fl_str_mv | Article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/article |
| description | Study objectiveTraumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and potentially enhance outcomes. Previous reviews suggested potential TXA benefits but did not consider the latest trials. MethodsA systematic review and bias-adjusted meta-analysis were performed to assess TXA’s effectiveness in emergency traumatic injury settings by pooling estimates from randomized controlled trials. Researchers searched Medline, Embase, and Cochrane Central for randomized controlled trials comparing TXA’s effects to a placebo in emergency trauma cases. The primary endpoint was 1-month mortality. The methodological quality of the trials underwent assessment using the MASTER scale, and the meta-analysis applied the quality-effects method to adjust for methodological quality. ResultsSeven randomized controlled trials met the set criteria. This meta-analysis indicated an 11% decrease in the death risk at 1 month after TXA use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84 to 0.95) with a number needed to treat of 61 to avoid 1 additional death. The meta-analysis also revealed reduced 24-hour mortality (OR 0.76, 95% CI 0.65 to 0.88) for TXA. No compelling evidence of increased vascular occlusive events emerged (OR 0.96, 95% CI 0.73 to 1.27). Subgroup analyses highlighted TXA’s effectiveness in general trauma versus traumatic brain injury and survival advantages when administered out-of-hospital versus inhospital. ConclusionsThis synthesis demonstrates that TXA use for trauma in emergencies leads to a reduction in 1-month mortality, with no significant evidence of problematic vascular occlusive events. Administering TXA in the out-of-hospital setting is associated with reduced mortality compared to inhospital administration, and less mortality with TXA in systemic trauma is noted compared with traumatic brain injury specifically. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | qu_3c987e35ce8e58a6332e947b280d1a5c |
| identifier_str_mv | Fouche, P. F., Stein, C., Nichols, M., Meadley, B., Bendall, J. C., Smith, K., ... & Doi, S. A. (2023). Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Annals of Emergency Medicine. 0196-0644 5 83 1097-6760 |
| language_invalid_str_mv | en |
| network_acronym_str | qu |
| network_name_str | Qatar University repository |
| oai_identifier_str | oai:qspace.qu.edu.qa:10576/55219 |
| publishDate | 2024 |
| publisher.none.fl_str_mv | Elsevier |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| spelling | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled TrialsPieter Francsois, FoucheStein, ChristopherNichols, MartinMeadley, BenjaminBendall, Jason C.Smith, KarenAnderson, DavidDoi, Suhail A.tranexamic acidemergency treatmentStudy objectiveTraumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and potentially enhance outcomes. Previous reviews suggested potential TXA benefits but did not consider the latest trials. MethodsA systematic review and bias-adjusted meta-analysis were performed to assess TXA’s effectiveness in emergency traumatic injury settings by pooling estimates from randomized controlled trials. Researchers searched Medline, Embase, and Cochrane Central for randomized controlled trials comparing TXA’s effects to a placebo in emergency trauma cases. The primary endpoint was 1-month mortality. The methodological quality of the trials underwent assessment using the MASTER scale, and the meta-analysis applied the quality-effects method to adjust for methodological quality. ResultsSeven randomized controlled trials met the set criteria. This meta-analysis indicated an 11% decrease in the death risk at 1 month after TXA use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84 to 0.95) with a number needed to treat of 61 to avoid 1 additional death. The meta-analysis also revealed reduced 24-hour mortality (OR 0.76, 95% CI 0.65 to 0.88) for TXA. No compelling evidence of increased vascular occlusive events emerged (OR 0.96, 95% CI 0.73 to 1.27). Subgroup analyses highlighted TXA’s effectiveness in general trauma versus traumatic brain injury and survival advantages when administered out-of-hospital versus inhospital. ConclusionsThis synthesis demonstrates that TXA use for trauma in emergencies leads to a reduction in 1-month mortality, with no significant evidence of problematic vascular occlusive events. Administering TXA in the out-of-hospital setting is associated with reduced mortality compared to inhospital administration, and less mortality with TXA in systemic trauma is noted compared with traumatic brain injury specifically.Elsevier2024-05-20T11:38:12Z2024-05Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1016/j.annemergmed.2023.10.004Fouche, P. F., Stein, C., Nichols, M., Meadley, B., Bendall, J. C., Smith, K., ... & Doi, S. A. (2023). Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Annals of Emergency Medicine.0196-0644https://www.sciencedirect.com/science/article/pii/S0196064423012817http://hdl.handle.net/10576/552195831097-6760enhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:qspace.qu.edu.qa:10576/552192025-05-25T09:45:56Z |
| spellingShingle | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials Pieter Francsois, Fouche tranexamic acid emergency treatment |
| status_str | publishedVersion |
| title | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| title_full | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| title_short | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| title_sort | Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials |
| topic | tranexamic acid emergency treatment |
| url | http://dx.doi.org/10.1016/j.annemergmed.2023.10.004 https://www.sciencedirect.com/science/article/pii/S0196064423012817 http://hdl.handle.net/10576/55219 |