Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury
IMPORTANCE: The development and expansion of intracranial hematoma are associated with adverse outcomes. Use of tranexamic acid might limit intracranial hematoma formation, but its association with outcomes of severe traumatic brain injury (TBI) is unclear. OBJECTIVE: To assess whether prehospital a...
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| Veröffentlicht in: | Archives of neurology (Chicago) 2021-03, Vol.78 (3), p.338-345 |
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| creator | Bossers, Sebastiaan M Loer, Stephan A Bloemers, Frank W Den Hartog, Dennis Van Lieshout, Esther M. M Hoogerwerf, Nico van der Naalt, Joukje Absalom, Anthony R Peerdeman, Saskia M Schwarte, Lothar A Boer, Christa Schober, Patrick |
| description | IMPORTANCE: The development and expansion of intracranial hematoma are associated with adverse outcomes. Use of tranexamic acid might limit intracranial hematoma formation, but its association with outcomes of severe traumatic brain injury (TBI) is unclear. OBJECTIVE: To assess whether prehospital administration of tranexamic acid is associated with mortality and functional outcomes in a group of patients with severe TBI. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study is an analysis of prospectively collected observational data from the Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) study in the Netherlands. Patients treated for suspected severe TBI by the Dutch Helicopter Emergency Medical Services between February 2012 and December 2017 were included. Patients were followed up for 1 year after inclusion. Data were analyzed from January 10, 2020, to September 10, 2020. EXPOSURES: Administration of tranexamic acid during prehospital treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included mortality at 1 year, functional neurological recovery at discharge (measured by Glasgow Outcome Scale), and length of hospital stay. Data were also collected on demographic factors, preinjury medical condition, injury characteristics, operational characteristics, and prehospital vital parameters. RESULTS: A total of 1827 patients were analyzed, of whom 1283 (70%) were male individuals and the median (interquartile range) age was 45 (23-65) years. In the unadjusted analysis, higher 30-day mortality was observed in patients who received prehospital tranexamic acid (odds ratio [OR], 1.34; 95% CI, 1.16-1.55; P |
| doi_str_mv | 10.1001/jamaneurol.2020.4596 |
| format | Article |
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M ; Hoogerwerf, Nico ; van der Naalt, Joukje ; Absalom, Anthony R ; Peerdeman, Saskia M ; Schwarte, Lothar A ; Boer, Christa ; Schober, Patrick</creator><creatorcontrib>Bossers, Sebastiaan M ; Loer, Stephan A ; Bloemers, Frank W ; Den Hartog, Dennis ; Van Lieshout, Esther M. M ; Hoogerwerf, Nico ; van der Naalt, Joukje ; Absalom, Anthony R ; Peerdeman, Saskia M ; Schwarte, Lothar A ; Boer, Christa ; Schober, Patrick ; BRAIN-PROTECT collaborators</creatorcontrib><description>IMPORTANCE: The development and expansion of intracranial hematoma are associated with adverse outcomes. Use of tranexamic acid might limit intracranial hematoma formation, but its association with outcomes of severe traumatic brain injury (TBI) is unclear. OBJECTIVE: To assess whether prehospital administration of tranexamic acid is associated with mortality and functional outcomes in a group of patients with severe TBI. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study is an analysis of prospectively collected observational data from the Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) study in the Netherlands. Patients treated for suspected severe TBI by the Dutch Helicopter Emergency Medical Services between February 2012 and December 2017 were included. Patients were followed up for 1 year after inclusion. Data were analyzed from January 10, 2020, to September 10, 2020. EXPOSURES: Administration of tranexamic acid during prehospital treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included mortality at 1 year, functional neurological recovery at discharge (measured by Glasgow Outcome Scale), and length of hospital stay. Data were also collected on demographic factors, preinjury medical condition, injury characteristics, operational characteristics, and prehospital vital parameters. RESULTS: A total of 1827 patients were analyzed, of whom 1283 (70%) were male individuals and the median (interquartile range) age was 45 (23-65) years. In the unadjusted analysis, higher 30-day mortality was observed in patients who received prehospital tranexamic acid (odds ratio [OR], 1.34; 95% CI, 1.16-1.55; P < .001), compared with patients who did not receive prehospital tranexamic acid. After adjustment for confounders, no association between prehospital administration of tranexamic acid and mortality was found across the entire cohort of patients. However, a substantial increase in the odds of 30-day mortality persisted in patients with severe isolated TBI who received prehospital tranexamic acid (OR, 4.49; 95% CI, 1.57-12.87; P = .005) and after multiple imputations (OR, 2.05; 95% CI, 1.22-3.45; P = .007). CONCLUSIONS AND RELEVANCE: This study found that prehospital tranexamic acid administration was associated with increased mortality in patients with isolated severe TBI, suggesting the judicious use of the drug when no evidence for extracranial hemorrhage is present.</description><identifier>ISSN: 2168-6149</identifier><identifier>EISSN: 2168-6157</identifier><identifier>DOI: 10.1001/jamaneurol.2020.4596</identifier><identifier>PMID: 33284310</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Acids ; Adult ; Aged ; Aircraft accidents ; Antifibrinolytic agents ; Antifibrinolytic Agents - administration & dosage ; Antifibrinolytic Agents - adverse effects ; Brain ; Brain Injuries, Traumatic - diagnosis ; Brain Injuries, Traumatic - drug therapy ; Brain Injuries, Traumatic - mortality ; Cohort Studies ; Comments ; Emergency medical services ; Emergency Medical Services - methods ; Emergency Medical Services - trends ; Epidemiology ; Female ; Head injuries ; Helicopters ; Hematoma ; Hemorrhage ; Humans ; Injury analysis ; Male ; Middle Aged ; Mortality ; Online First ; Original Investigation ; Patients ; Prospective Studies ; Recovery of function ; Retrospective Studies ; Severity of Illness Index ; Tranexamic Acid - administration & dosage ; Tranexamic Acid - adverse effects ; Traumatic brain injury ; Treatment Outcome ; Young Adult</subject><ispartof>Archives of neurology (Chicago), 2021-03, Vol.78 (3), p.338-345</ispartof><rights>Copyright American Medical Association Mar 2021</rights><rights>Copyright 2020 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a455t-a50b688309917c844d4254e34957f44c10112869b16f962f721ff373a2022b4c3</citedby><cites>FETCH-LOGICAL-a455t-a50b688309917c844d4254e34957f44c10112869b16f962f721ff373a2022b4c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamaneurology/articlepdf/10.1001/jamaneurol.2020.4596$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2020.4596$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33284310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bossers, Sebastiaan M</creatorcontrib><creatorcontrib>Loer, Stephan A</creatorcontrib><creatorcontrib>Bloemers, Frank W</creatorcontrib><creatorcontrib>Den Hartog, Dennis</creatorcontrib><creatorcontrib>Van Lieshout, Esther M. M</creatorcontrib><creatorcontrib>Hoogerwerf, Nico</creatorcontrib><creatorcontrib>van der Naalt, Joukje</creatorcontrib><creatorcontrib>Absalom, Anthony R</creatorcontrib><creatorcontrib>Peerdeman, Saskia M</creatorcontrib><creatorcontrib>Schwarte, Lothar A</creatorcontrib><creatorcontrib>Boer, Christa</creatorcontrib><creatorcontrib>Schober, Patrick</creatorcontrib><creatorcontrib>BRAIN-PROTECT collaborators</creatorcontrib><title>Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury</title><title>Archives of neurology (Chicago)</title><addtitle>JAMA Neurol</addtitle><description>IMPORTANCE: The development and expansion of intracranial hematoma are associated with adverse outcomes. Use of tranexamic acid might limit intracranial hematoma formation, but its association with outcomes of severe traumatic brain injury (TBI) is unclear. OBJECTIVE: To assess whether prehospital administration of tranexamic acid is associated with mortality and functional outcomes in a group of patients with severe TBI. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study is an analysis of prospectively collected observational data from the Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) study in the Netherlands. Patients treated for suspected severe TBI by the Dutch Helicopter Emergency Medical Services between February 2012 and December 2017 were included. Patients were followed up for 1 year after inclusion. Data were analyzed from January 10, 2020, to September 10, 2020. EXPOSURES: Administration of tranexamic acid during prehospital treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included mortality at 1 year, functional neurological recovery at discharge (measured by Glasgow Outcome Scale), and length of hospital stay. Data were also collected on demographic factors, preinjury medical condition, injury characteristics, operational characteristics, and prehospital vital parameters. RESULTS: A total of 1827 patients were analyzed, of whom 1283 (70%) were male individuals and the median (interquartile range) age was 45 (23-65) years. In the unadjusted analysis, higher 30-day mortality was observed in patients who received prehospital tranexamic acid (odds ratio [OR], 1.34; 95% CI, 1.16-1.55; P < .001), compared with patients who did not receive prehospital tranexamic acid. After adjustment for confounders, no association between prehospital administration of tranexamic acid and mortality was found across the entire cohort of patients. However, a substantial increase in the odds of 30-day mortality persisted in patients with severe isolated TBI who received prehospital tranexamic acid (OR, 4.49; 95% CI, 1.57-12.87; P = .005) and after multiple imputations (OR, 2.05; 95% CI, 1.22-3.45; P = .007). CONCLUSIONS AND RELEVANCE: This study found that prehospital tranexamic acid administration was associated with increased mortality in patients with isolated severe TBI, suggesting the judicious use of the drug when no evidence for extracranial hemorrhage is present.</description><subject>Acids</subject><subject>Adult</subject><subject>Aged</subject><subject>Aircraft accidents</subject><subject>Antifibrinolytic agents</subject><subject>Antifibrinolytic Agents - administration & dosage</subject><subject>Antifibrinolytic Agents - adverse effects</subject><subject>Brain</subject><subject>Brain Injuries, Traumatic - diagnosis</subject><subject>Brain Injuries, Traumatic - drug therapy</subject><subject>Brain Injuries, Traumatic - mortality</subject><subject>Cohort Studies</subject><subject>Comments</subject><subject>Emergency medical services</subject><subject>Emergency Medical Services - methods</subject><subject>Emergency Medical Services - trends</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Head injuries</subject><subject>Helicopters</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Injury analysis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Online First</subject><subject>Original Investigation</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Recovery of function</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Tranexamic Acid - administration & dosage</subject><subject>Tranexamic Acid - adverse effects</subject><subject>Traumatic brain injury</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>2168-6149</issn><issn>2168-6157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkVtrVDEUhYMottT-AREJ-OLLjLns3F6EaalaKFSwPodMTo7NcE4yJue09t83w9TxkpcE9rd21t4LoTeULCkh9MPGjS6FueRhyQgjSxBGPkPHjEq9kFSo54c3mCN0WuuGtKMJAQ4v0RHnTAOn5BgNq1qzj26KOeGzMN2HkPDXEm5z3cbJDfimtI9-uTF6vPKxw6tujCnWqewlLnX4ep58HkPFucffwl0oYaeax0Z4fFZcTPgybeby8Aq96N1Qw-nTfYK-f7q4Of-yuLr-fHm-ulo4EGJaOEHWUmtOjKHKa4AOmIDAwQjVA3hKKGVamjWVvZGsV4z2PVfctVWwNXh-gj7u-27n9Rg6H1KzO9htiaMrDza7aP-tpHhrf-Q7q4zgTInW4P1Tg5J_zqFOdozVh2Fou8hztQyk0kC1kA199x-6yXNJbTzLBFFUNduqUbCnfMm1ltAfzFBid4naP4naXaJ2l2iTvf17kIPod34NeL0HmvpQZUpxwQx_BGuYp-o</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Bossers, Sebastiaan M</creator><creator>Loer, Stephan A</creator><creator>Bloemers, Frank W</creator><creator>Den Hartog, Dennis</creator><creator>Van Lieshout, Esther M. M</creator><creator>Hoogerwerf, Nico</creator><creator>van der Naalt, Joukje</creator><creator>Absalom, Anthony R</creator><creator>Peerdeman, Saskia M</creator><creator>Schwarte, Lothar A</creator><creator>Boer, Christa</creator><creator>Schober, Patrick</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210301</creationdate><title>Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury</title><author>Bossers, Sebastiaan M ; Loer, Stephan A ; Bloemers, Frank W ; Den Hartog, Dennis ; Van Lieshout, Esther M. M ; Hoogerwerf, Nico ; van der Naalt, Joukje ; Absalom, Anthony R ; Peerdeman, Saskia M ; Schwarte, Lothar A ; Boer, Christa ; Schober, Patrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a455t-a50b688309917c844d4254e34957f44c10112869b16f962f721ff373a2022b4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acids</topic><topic>Adult</topic><topic>Aged</topic><topic>Aircraft accidents</topic><topic>Antifibrinolytic agents</topic><topic>Antifibrinolytic Agents - administration & dosage</topic><topic>Antifibrinolytic Agents - adverse effects</topic><topic>Brain</topic><topic>Brain Injuries, Traumatic - diagnosis</topic><topic>Brain Injuries, Traumatic - drug therapy</topic><topic>Brain Injuries, Traumatic - mortality</topic><topic>Cohort Studies</topic><topic>Comments</topic><topic>Emergency medical services</topic><topic>Emergency Medical Services - methods</topic><topic>Emergency Medical Services - trends</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Head injuries</topic><topic>Helicopters</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Injury analysis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Online First</topic><topic>Original Investigation</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Recovery of function</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Tranexamic Acid - administration & dosage</topic><topic>Tranexamic Acid - adverse effects</topic><topic>Traumatic brain injury</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bossers, Sebastiaan M</creatorcontrib><creatorcontrib>Loer, Stephan A</creatorcontrib><creatorcontrib>Bloemers, Frank W</creatorcontrib><creatorcontrib>Den Hartog, Dennis</creatorcontrib><creatorcontrib>Van Lieshout, Esther M. M</creatorcontrib><creatorcontrib>Hoogerwerf, Nico</creatorcontrib><creatorcontrib>van der Naalt, Joukje</creatorcontrib><creatorcontrib>Absalom, Anthony R</creatorcontrib><creatorcontrib>Peerdeman, Saskia M</creatorcontrib><creatorcontrib>Schwarte, Lothar A</creatorcontrib><creatorcontrib>Boer, Christa</creatorcontrib><creatorcontrib>Schober, Patrick</creatorcontrib><creatorcontrib>BRAIN-PROTECT collaborators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of neurology (Chicago)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bossers, Sebastiaan M</au><au>Loer, Stephan A</au><au>Bloemers, Frank W</au><au>Den Hartog, Dennis</au><au>Van Lieshout, Esther M. M</au><au>Hoogerwerf, Nico</au><au>van der Naalt, Joukje</au><au>Absalom, Anthony R</au><au>Peerdeman, Saskia M</au><au>Schwarte, Lothar A</au><au>Boer, Christa</au><au>Schober, Patrick</au><aucorp>BRAIN-PROTECT collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury</atitle><jtitle>Archives of neurology (Chicago)</jtitle><addtitle>JAMA Neurol</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>78</volume><issue>3</issue><spage>338</spage><epage>345</epage><pages>338-345</pages><issn>2168-6149</issn><eissn>2168-6157</eissn><abstract>IMPORTANCE: The development and expansion of intracranial hematoma are associated with adverse outcomes. Use of tranexamic acid might limit intracranial hematoma formation, but its association with outcomes of severe traumatic brain injury (TBI) is unclear. OBJECTIVE: To assess whether prehospital administration of tranexamic acid is associated with mortality and functional outcomes in a group of patients with severe TBI. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study is an analysis of prospectively collected observational data from the Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) study in the Netherlands. Patients treated for suspected severe TBI by the Dutch Helicopter Emergency Medical Services between February 2012 and December 2017 were included. Patients were followed up for 1 year after inclusion. Data were analyzed from January 10, 2020, to September 10, 2020. EXPOSURES: Administration of tranexamic acid during prehospital treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included mortality at 1 year, functional neurological recovery at discharge (measured by Glasgow Outcome Scale), and length of hospital stay. Data were also collected on demographic factors, preinjury medical condition, injury characteristics, operational characteristics, and prehospital vital parameters. RESULTS: A total of 1827 patients were analyzed, of whom 1283 (70%) were male individuals and the median (interquartile range) age was 45 (23-65) years. In the unadjusted analysis, higher 30-day mortality was observed in patients who received prehospital tranexamic acid (odds ratio [OR], 1.34; 95% CI, 1.16-1.55; P < .001), compared with patients who did not receive prehospital tranexamic acid. After adjustment for confounders, no association between prehospital administration of tranexamic acid and mortality was found across the entire cohort of patients. However, a substantial increase in the odds of 30-day mortality persisted in patients with severe isolated TBI who received prehospital tranexamic acid (OR, 4.49; 95% CI, 1.57-12.87; P = .005) and after multiple imputations (OR, 2.05; 95% CI, 1.22-3.45; P = .007). CONCLUSIONS AND RELEVANCE: This study found that prehospital tranexamic acid administration was associated with increased mortality in patients with isolated severe TBI, suggesting the judicious use of the drug when no evidence for extracranial hemorrhage is present.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>33284310</pmid><doi>10.1001/jamaneurol.2020.4596</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 2168-6149 2168-6157 |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Acids Adult Aged Aircraft accidents Antifibrinolytic agents Antifibrinolytic Agents - administration & dosage Antifibrinolytic Agents - adverse effects Brain Brain Injuries, Traumatic - diagnosis Brain Injuries, Traumatic - drug therapy Brain Injuries, Traumatic - mortality Cohort Studies Comments Emergency medical services Emergency Medical Services - methods Emergency Medical Services - trends Epidemiology Female Head injuries Helicopters Hematoma Hemorrhage Humans Injury analysis Male Middle Aged Mortality Online First Original Investigation Patients Prospective Studies Recovery of function Retrospective Studies Severity of Illness Index Tranexamic Acid - administration & dosage Tranexamic Acid - adverse effects Traumatic brain injury Treatment Outcome Young Adult |
| title | Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury |
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