EARLY PREHOSPITAL TRANEXAMIC ACID FOLLOWING INJURY IS ASSOCIATED WITH A 30-DAY SURVIVAL BENEFIT: A SECONDARY ANALYSIS OF A RANDOMIZED CLINICAL TRIAL
*Shimena Li1, *Francis Guyette1, *Joshua Brown1, *Mazen Zenati1, *Brian Eastridge2, *Raminder Nirula3, *Gary Vercruysse4, *Terence O'Keeffe4, *Bellal Joseph4, *Matthew Neal1, Brian Zuckerbraun1, Jason Sperry1
1University of Pittsburgh, Pittsburgh, PA;2University of Texas Health San Antonio, San Antonio, TX;3University of Utah, Salt Lake City, UT;4University of Arizona, Tucson, AZ
OBJECTIVE: Tranexamic Acid (TXA) has been shown to be safe if initiated in the prehospital setting post-injury. We sought to characterize the early administration of prehospital TXA (1hr from injury).METHODS: We performed a secondary analysis of a recent prehospital randomized TXA clinical trial in injured patients. Those who received prehospital TXA within 1hr (EARLY) from time of injury were compared to those who received TXA later (DELAYED). We included patients in compensated shock (shock index of > 0.9). Primary outcome was 30-day mortality. Secondary outcomes included incidence of multiple organ failure (MOF) and early transfusion requirements.RESULTS: EARLY and DELAYED patients had similar demographics, injury characteristics and shock severity. Stratified Kaplan-Meier curves (Figure) demonstrated a significant separation for EARLY patients (n=238, p=0.02) with no separation in DELAYED patients (n=238 p=0.83) Stratified Cox hazard regression verified, after controlling for important confounders, prehospital TXA was associated with a 70% lower independent hazard for 30-day mortality in EARLY patients (HR 0.30 ,95% CI 0.08-0.90, p= 0.03) with no association found in DELAYED patients (p=0.96). In EARLY patients, TXA was associated with a significant lower incidence of MOF and lower 24hr blood transfusion requirements.CONCLUSIONS: Prehospital TXA in patients with compensated shock is associated with a 30-day survival benefit and resulted in a lower incidence of multiple organ failure and lower transfusion requirements if provided within 1-hour from injury. 
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