Praveen Kumar, S (2020) Tranexamic Acid use in Severely injured patients with Significant Haemorrhage: A Prospective Cohort study. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Injuries following trauma are a major cause of morbidity and mortality worldwide. It is predicted that injuries may contribute to 20% of all causes by the year 2020. Trauma remains a major cause of death in individuals younger than the age of 45 years throughout the world. These individuals suffer from life threatening complications due to severe haemorrhage which further aggravates the immune system response leading to more tissue damage. Haemorrhage due to traumatic injuries contributes one third of trauma deaths and also cause death by multiorgan failure. The haemostatic system maintains blood circulation following vascular injury in trauma. In response to surgery or trauma fibrinolysis occurs and may become pathologically hyper fibrinolytic. This poses a challenge to the circulatory system following severe blood loss. Tranexamic acid is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis by blocking the lysine binding sites on plasminogen. Tranexamic Acid (TXA) is used as an anti-fibrinolytic agent to reduce surgical bleeding if administered prior to or during surgery, and to improve survival in trauma if given early after trauma. A large, randomized control trial CRASH 2 across 274 hospitals in 40 countries studied the use of tranexamic acid in bleeding trauma patients & proposed that early use of tranexamic acid in patients, with or at risk of significant bleeding, resulted in significant reduction in mortality. Tranexamic acid use has also been found to be beneficial in the military setting in combat trauma. Tranexamic acid has especially found to be beneficial in severely injured patients with shock in a mature civilian trauma setup with improved morbidity and mortality. There was reduced mortality for patients receiving tranexamic acid in spite of their increased acuity and decreased likelihood of survival. Trauma patients receiving tranexamic acid demonstrate decreased mortality in spite of increased acuity and increased transfusion requirements. The following study analyses the effect of tranexamic acid on mortality and other clinical outcomes in a severely injured trauma patient with significant haemorrhage in a civilian tertiary trauma care setup. METHODOLOGY OBJECTIVES: 1. To determine the relationship between tranexamic acid use and patient outcomes in a severely injured civilian cohort. 2. To determine differential effects between patients who presented with or without shock. METHODOLOGY: a) SOURCE OF DATA: Patients admitted in the emergency trauma centre of Stanley Medical College hospital,Chennai. b) METHOD OF COLLECTION OF DATA (including sampling g procedure, if any): Data Collected: 1. Patient demographics, 2. Mode of Injury, 3. Mechanism of Injury(Blunt/Penetrating), 4. Injury Severity Score, 5. Abbreviated Injury Score, 6. Glasgow Coma Score, 7. Systolic BP, 8. Details of transfusions in first 24 hrs from injury. 9. Post transfusion Haemoglobin after 24 hrs. 10. Fluid resuscitation details Outcomes to be recorded: 1. Mortality < 48hrs, 2. Mortality > 48hrs, 3. Cause of Mortality, 4. Critical Care length of stay. c.)INCLUSION CRITERIA: 1. Age > 15yrs, 2. Injury Severity Score >15 with or without active haemorrhage. EXCLUSION CRITERIA: 1. Age < 15 years, 2. Injury Severity Score ≤15, 3. Duration from time of injury >3hrs, 4. GCS Score ≤8. SUMMARY OF RESULTS: 1. The most common mode of injury was Road Traffic Accidents (RTA) contributing to 89 cases(64.5%), followed by assault with 21 cases( 15.2%). There were 12 cases (8.7%) due to accidental injury and 12 cases (8.7%) due to accidental fall. 3 cases were due to self inflicted injury (2.2%) and 1 case due to Train Traffic Accident (0.7%). 2. The most common mode of injury in tranexamic group-was due to penetrating trauma with 34 cases(60.7%) followed by blunt trauma with 22 cases (39.3%). 3. The average duration from time of injury to administration of loading dose tranexamic acid was 124 minutes. 4. The Mean Age was 38.49 years. The Median Age was 36.50 years. Trauma was found to be most commonly affecting the middle aged group. 5. Tranexamic acid group cases had more significant severity of injury (p<0.05) when compared to the non tranexamic acid group. 6. The Tranexamic acid group patients had significantly tachycardia ( p<0.05) owing to the volume low due to active bleeding and increased acuity of injury. 7. The Tranexamic acid group was found to be significantly tachypneic during admission when compared to the non tranexamic acid group (p< 0.05). 8. The Tranexamic acid group was found to be slightly hypoxic when compared to the non tranexamic acid group which was found to be statistically significant (p<0.05) 9. The Tranexamic acid group was found to have higher intravenous fluids requirement when compared to the non tranexamic acid group( p <0.05). 10. There was a significant requirement of transfusions in the tranexamic acid group when compared to the non tranexamic acid group (p<0.05). 11. Compared with the non tranexamic acid group, there was no significant difference between the critical care stay duration of the tranexamic acid group (p>0.05), indicating that though the tranexamic cohort was more severely injured the critical care requirement is shortened. 12. No adverse drug reactions were observed during the period of study 13. No mortality was observed during the period of study. CONCLUSION: 1. Tranexamic acid can be used as a part of massive haemorrhage protocol in a trauma care setup with shorter duration of critical care stay and improved survival. 2. Tranexemic acid administration is not associated with any adverse drug reactions. 3. There is no risk of thrombosis due to use of tranexamic acid within 3hrs of trauma in severely injured trauma patients.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711063 |
| Uncontrolled Keywords: | Tranexamic Acid, Severely injured patients, Significant Haemorrhage, Prospective Cohort study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 01:48 |
| Last Modified: | 09 Feb 2021 01:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13950 |
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