Association of cryoprecipitate and tranexamic acid With improved survival following wartime injury: findings from the MATTERs II Study

作者: Jonathan J. Morrison , James D. Ross , Joseph J. Dubose , Jan O. Jansen , Mark J. Midwinter

DOI: 10.1001/JAMASURG.2013.764

关键词:

摘要: Objective To quantify the impact of fibrinogen-containing cryoprecipitate in addition to antifibrinolytic tranexamic acid on survival in combat injured. Design Retrospective observational study comparing mortality of 4 groups: only, cryoprecipitate acid and cryoprecipitate, and neither nor cryoprecipitate. To balance comparisons, propensity scores were developed added as covariates logistic regression models predicting mortality. Setting A Role 3 Combat Surgical Hospital in southern Afghanistan. Patients total 1332 patients identified from prospectively collected UK US trauma registries who required 1 U or more of packed red blood cells composed following tranexamic acid (n = 148), (n = 168), tranexamic acid/cryoprecipitate (n = 258), no acid/cryoprecipitate (n = 758). Main Outcome Measure In-hospital Results Injury Severity Scores highest (mean [SD], 28.3 [15.7]) acid/cryoprecipitate (mean [SD], 26 [14.9]) groups compared with [SD], 23.0 [19.2]) 21.2 [18.5]) (P < .001) groups. Despite greater Injury packed cell requirements, mortality was lowest (11.6%) (18.2%) (21.4%) and no (23.6%) Tranexamic independently associated a similarly reduced (odds ratio, 0.61; 95% CI, 0.42-0.89; P = .01 odds 0.40-0.94; P = .02, respectively). The combined tranexamic effect vs synergy model had an ratio 0.34 (95% 0.20-0.58; P < .001), reflecting nonsignificant interaction (P = .21). Conclusions Cryoprecipitate may add benefit of seriously injured requiring transfusion. Additional is necessary define role fibrinogen in resuscitation hemorrhagic shock.

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