title: Time since injury is the major factor in preventing tranexamic acid use in the trauma setting: An observational cohort study from a major trauma centre in a middle-income country.
abstract: BACKGROUND
  Haemorrhage is responsible for about a third of in-hospital trauma deaths. The CRASH-2 trial demonstrated that early administration of tranexamic acid, ideally within 3 hours, can reduce mortality from trauma-associated bleeding by up to 32%.
  
  
  OBJECTIVE
  To explore whether, in our trauma network in a middle-income country, patients arrived at hospital soon enough after injury for tranexamic acid administration to be effective and safe.
  
  
  METHODS
  A prospective cohort study of 50 consecutive patients admitted to our trauma unit was undertaken. Inclusion criteria were as for the CRASH-2 study: systolic blood pressure &lt;90 mmHg and/or heart rate &gt;110 beats per minute, with injuries suggestive of a risk of haemorrhage. Patients with isolated head injuries were excluded. The mechanisms of injury, time since injury and any reasons for delay were recorded.
  
  
  RESULTS
  Thirteen (26%) patients presented early enough for tranexamic acid administration. Of these, only three patients presented within the 1st hour. Eleven patients had a documented time of injury &gt;3 hours prior to presentation. We were unsure of the time of injury for 26 patients, although for most of these it was likely to be &gt;3 hours before presentation.
  
  
  CONCLUSIONS
  The majority (74%) of bleeding trauma patients did not present within the timeframe allowed for safe administration of tranexamic therapy. Of those who did, most would have benefited from even earlier commencement of therapy. This raises the possibility that tranexamic acid may be more effective on a population basis if incorporated into prehospital rather than in-hospital protocols; future studies should explore the benefits and risks of this approach.
authors.affiliation: Trinity College, Oxford University, UK. benjamin.thurston@gmail.com.
authors.forename: Ben
authors.initials: B
authors.lastname: Thurston
authors.forename: Sharfuddin
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Sorin
authors.initials: S
authors.lastname: Edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: Pradeep Harkison
authors.initials: PH
authors.lastname: Navsaria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013019:South Africa; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid