Association of Cryoprecipitate and Tranexamic Acid with Improved Survival Following Wartime Injury: Findings from the MATTERs II Study
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
Objective To quantify the impact of fibrinogen-containing cryoprecipitate in addition to the antifibrinolytic tranexamic acid on survival in combat injured. Design Retrospective observational study comparing the mortality of4groups tranexamic acid only, cryoprecipitate only, tranexamic acid and cryoprecipitate, and neither tranexamic acid nor cryoprecipitate. To balance comparisons, propensity scores were developed and added as covariates to logistic regression models predicting mortality. Setting A Role 3 Combat Surgical Hospital in southern Afghanistan. Patients A total of 1332 patients were identified from prospectively collected UK and US trauma registries who required 1 U or more of packed red blood cells and composed the following groups tranexamic acid n148, cryoprecipitate n168, tranexamic acidcryoprecipitate n258, and no tranexamic acidcryoprecipitate n758. Main Outcome Measure In-hospital mortality. Results Injury Severity Scores were highest in the cryoprecipitate mean SD, 28.3 15.7 and tranexamic acidcryoprecipitate mean SD, 26 14.9 groups compared with the tranexamic acid mean SD, 23.0 19.2 and no tranexamic acidcryoprecipitate mean SD, 21.2 18.5 P.001 groups. Despite greater Injury Severity Scores and packed red blood cell requirements, mortality was lowest in the tranexamic acidcryoprecipitate 11.6 and tranexamic acid 18.2 groups compared with the cryoprecipitate 21.4 and no tranexamic acid cryoprecipitate 23.6 groups. Tranexamic acid and cryoprecipitate were independently associated with a similarly reduced mortality odds ratio, 0.61 95 CI, 0.42- 0.89 P.01 and odds ratio, 0.61 95 CI, 0.40-0.94 P.02, respectively. The combined tranexamic acid and cryoprecipitate effect vs neither in a synergy model had an odds ratio of 0.34 95 CI, 0.20-0.58 P.001, reflecting nonsignificant interaction P.21.
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