title: Association of cryoprecipitate and tranexamic acid with improved survival following wartime injury: findings from the MATTERs II Study.
abstract: OBJECTIVE
  To quantify the impact of fibrinogen-containing cryoprecipitate in addition to the antifibrinolytic tranexamic acid on survival in combat injured.
  
  
  METHODS
  Retrospective observational study comparing the mortality of 4 groups: 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.
  
  
  METHODS
  A Role 3 Combat Surgical Hospital in southern Afghanistan.
  
  
  METHODS
  A total of 1332 patients were identified from prospectively collected U.K. and U.S. trauma registries who required 1 U or more of packed red blood cells and composed the following groups: tranexamic acid (n = 148), cryoprecipitate (n = 168), tranexamic acid/cryoprecipitate (n = 258), and no tranexamic acid/cryoprecipitate (n = 758).
  
  
  METHODS
  In-hospital mortality.
  
  
  RESULTS
  Injury severity scores were highest in the cryoprecipitate (mean [SD], 28.3 [15.7]) and tranexamic acid/cryoprecipitate (mean [SD], 26 [14.9]) groups compared with the tranexamic acid (mean [SD], 23.0 [19.2]) and no tranexamic acid/cryoprecipitate (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 acid/cryoprecipitate (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).
  
  
  CONCLUSIONS
  Cryoprecipitate may independently add to the survival benefit of tranexamic acid in the seriously injured requiring transfusion. Additional study is necessary to define the role of fibrinogen in resuscitation from hemorrhagic shock.
authors.affiliation: National Institute of Health Research, New Queen Elizabeth Hospital.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Morrison
authors.forename: James D
authors.initials: JD
authors.lastname: Ross
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Dubose
authors.forename: Jan O
authors.initials: JO
authors.lastname: Jansen
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Midwinter
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
mesh_terms: D000346:Afghanistan; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005169:Factor VIII / Q000008:administration & dosage*; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D014148:Tranexamic Acid / Q000008:administration & dosage*; D006113:United Kingdom; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; C026912:cryoprecipitate coagulum; D014148:Tranexamic Acid; D005169:Factor VIII; D005340:Fibrinogen