title: Effectiveness of early administration of tranexamic acid in patients with severe trauma.
abstract: BACKGROUND
  A reduction in mortality with the early use of tranexamic acid has been demonstrated in severely injured patients who are bleeding. However, the modest treatment effect with no reduction in blood transfusion has raised concerns. The aim of the present study was to estimate the effectiveness of regular use of tranexamic acid in severely injured patients.
  
  
  METHODS
  This multicentre observational study used retrospectively collected data from consecutive injured patients (Injury Severity Score at least 16) treated in 15 Japanese academic institutions in 2012. A propensity score-matched analysis compared patients who did or did not receive tranexamic acid administration within 3 h of injury. Study outcomes included 28-day all-cause and cause-specific mortality, and need for blood transfusion.
  
  
  RESULTS
  Of 796 eligible subjects, 281 were treated with tranexamic acid. Propensity score matching selected a total of 500 matched subjects (250 in each group). Tranexamic acid administration was associated with lower 28-day mortality (10·0 versus 18·4 per cent; difference -8·4 (95 per cent c.i. -14·5 to -2·3) per cent) and lower 28-day mortality from primary brain injury (6·0 versus 13·2 per cent; difference -7·2 (-12·3 to -2·1) per cent). However, there was no significant difference between groups in the need for blood transfusion (33·2 versus 34·8 per cent; difference -1·6 (-9·9 to 6·7) per cent).
  
  
  CONCLUSIONS
  Early tranexamic acid use was associated with reduced mortality in severely injured patients, in particular those with a primary brain injury.
authors.affiliation: Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Japan.|Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-9192-625X
authors.initials: A
authors.lastname: Shiraishi
authors.affiliation: Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kushimoto
authors.affiliation: Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Otomo
authors.affiliation: Clinical Research Support Office, Kameda Medical Center, Kamogawa, Japan.|Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Hagiwara
authors.affiliation: Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Murata
mesh_terms: D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001930:Brain Injuries / Q000401:mortality / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid