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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2023

Open Access 16-12-2022 | Central Nervous System Trauma | Review Article

Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review

Authors: Annalisa Biffi, Gloria Porcu, Greta Castellini, Antonello Napoletano, Daniela Coclite, Daniela D’Angelo, Alice Josephine Fauci, Laura Iacorossi, Roberto Latina, Katia Salomone, Primiano Iannone, Silvia Gianola, Osvaldo Chiara, the Italian National Institute of Health Guideline Working Group

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2023

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Abstract

Purpose

The effect of systemic hemostatic agents initiated during pre-hospital care of severely injured patients with ongoing bleeding or traumatic brain injury (TBI) remains controversial. A systematic review and meta-analysis was therefore conducted to assess the effectiveness and safety of systemic hemostatic agents as an adjunctive therapy in people with major trauma and hemorrhage or TBI in the context of developing the Italian National Institute of Health guidelines on major trauma integrated management.

Methods

PubMed, Embase, and Cochrane Library databases were searched up to October 2021 for studies that investigated pre-hospital initiated treatment with systemic hemostatic agents. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach, and the quality of each study was determined with the Cochrane risk-of-bias tool. The primary outcome was overall mortality, and secondary outcomes included cause-specific mortality, health-related quality of life, any adverse effects and blood product use, hemorrhage expansion, and patient-reported outcomes.

Results

Five trials of tranexamic acid (TXA) met the inclusion criteria for this meta-analysis. With a high certainty of evidence, when compared to placebo TXA reduced mortality at 24 h (relative risk = 0.83, 95% confidence interval = 0.73–0.94) and at 1 month among trauma patients (0.91, 0.85–0.97). These results depend on the subgroup of patients with significant hemorrhage because in the subgroup of TBI there are no difference between TXA and placebo. TXA also reduced bleeding death and multiple organ failure whereas no difference in health-related quality of life.

Conclusion

Balancing benefits and harms, TXA initiated in the pre-hospital setting can be used for patients experiencing major trauma with significant hemorrhage since it reduces the risk of mortality at 24 h and one month with no difference in terms of adverse effects when compared to placebo. Considering the subgroup of severe TBI, no difference in mortality rate was found at 24 h and one month. These results highlight the need to conduct future studies to investigate the role of other systemic hemostatic agents in the pre-hospital settings.
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Metadata
Title
Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review
Authors
Annalisa Biffi
Gloria Porcu
Greta Castellini
Antonello Napoletano
Daniela Coclite
Daniela D’Angelo
Alice Josephine Fauci
Laura Iacorossi
Roberto Latina
Katia Salomone
Primiano Iannone
Silvia Gianola
Osvaldo Chiara
the Italian National Institute of Health Guideline Working Group
Publication date
16-12-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-02185-6

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