title: Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study.
abstract: OBJECTIVE
  To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality.
  
  
  METHODS
  Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival.
  
  
  METHODS
  A Role 3 Echelon surgical hospital in southern Afghanistan.
  
  
  METHODS
  A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries.
  
  
  METHODS
  Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications.
  
  
  RESULTS
  The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P < .001). This benefit was greatest in the group of patients who received massive transfusion (14.4% vs 28.1%, respectively; P = .004), where TXA was also independently associated with survival (odds ratio = 7.228; 95% CI, 3.016-17.322) and less coagulopathy (P = .003).
  
  
  CONCLUSIONS
  The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
authors: US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-6315, USA.
authors: Jonathan J
authors: JJ
authors: Morrison
authors: Joseph J
authors: JJ
authors: Dubose
authors: Todd E
authors: TE
authors: Rasmussen
authors: Mark J
authors: MJ
authors: Midwinter
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001753:Blast Injuries / Q000150:complications; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002985:Clinical Protocols; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D015999:Multivariate Analysis; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D014148:Tranexamic Acid / Q000627:therapeutic use*; D014481:United States; D014947:Wounds and Injuries / Q000150:complications; D014948:Wounds, Gunshot / Q000150:complications; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid