Professor Paul Young
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Intensive Care Specialist, Wellington Regional Hospital, NZ
Paul Young is an intensive care specialist and co-clinical leader at Wellington Hospital ICU. He is a Deputy Director at the Medical Research Institute of New Zealand. He is an active clinical researcher and has published more than 250 papers in peer-reviewed journals.
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Pre-Hospital Anti-Fibrinolytics for Traumatic Coagulopathy and Haemorrhage
In the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH)-2 trial, tranexamic acid (TXA), administered within 3 hours of injury, was reported to reduce 28-day mortality. Most patients in the CRASH-2 trial were recruited in centres that did not have advanced trauma systems. Moreover, because the CRASH-2 trial did not follow patients beyond hospital discharge, the effect of TXA on long-term survival with a favourable outcome is unknown.
The PATCH study was designed to test the hypothesis that TXA, initiated pre-hospital in advanced trauma systems in patients with severe trauma who had a high risk of coagulopathy, would increase survival with favourable functional outcome at six months. In the trial, this occurred in 53.7% patients in the tranexamic acid group and 53.5% in the placebo group (risk ratio (RR) 1.00; 95% confidence interval [CI], 0.90 to 1.12; P=0.95). For every 100 patients treated with TXA instead of placebo there were four extra patients who were alive at six months. In the TXA group, for every 100 patients treated there were an extra four patients severely disabled survivors (who required full assistance with ALL activities of daily living).
TXA appears to decrease deaths but increase fully dependent survivors. Accordingly, the question of whether TXA should remain standard care within our trauma system is complex.
The PATCH study was designed to test the hypothesis that TXA, initiated pre-hospital in advanced trauma systems in patients with severe trauma who had a high risk of coagulopathy, would increase survival with favourable functional outcome at six months. In the trial, this occurred in 53.7% patients in the tranexamic acid group and 53.5% in the placebo group (risk ratio (RR) 1.00; 95% confidence interval [CI], 0.90 to 1.12; P=0.95). For every 100 patients treated with TXA instead of placebo there were four extra patients who were alive at six months. In the TXA group, for every 100 patients treated there were an extra four patients severely disabled survivors (who required full assistance with ALL activities of daily living).
TXA appears to decrease deaths but increase fully dependent survivors. Accordingly, the question of whether TXA should remain standard care within our trauma system is complex.
