PATCH-Trauma Trial Review: Should We Use Prehospital Tranexamic Acid for Traumatically Bleeding Patients?
An interesting research publication in The New England Journal of Medicine has been added to the ongoing discussion of how to manage traumatically bleeding patients in the prehospital setting. The PATCH-Trauma trial (Pre-hospital Antifibrinolytics for Traumatic Coagulopathy and Hemorrhage) investigated whether prehospital administration of tranexamic acid improves the functional survival of adults with major traumatic injuries. The discussion of how to manage these patients in the prehospital setting is an important ongoing discussion, as there are significant challenges involved in making blood available in remote locations for patients with traumatic injuries. Carter BloodCare provides prehospital transfusion support for several air and ground ambulance services in our community. We work with first responders in our community in order to better serve those patients suffering from traumatic injuries who need life-saving blood in the field.
Traumatic coagulopathy is often attributed to fibrinolysis, so the PATCH investigators hypothesized that using a prehospital antifibrinolytic drug, tranexamic acid, would improve functional survival when compared to a control arm. They hoped that prehospital tranexamic acid might help manage the coagulopathy often associated with traumatically bleeding patients. In the trial, adult patients with major trauma were randomly assigned to receive prehospital tranexamic acid as well as another dose of tranexamic acid within 8 hours of arriving to the hospital. This group was compared to a control group who received a placebo.
The primary endpoint of the trial was “survival with a favorable functional outcome at six months.” The results showed that there was no significant difference between those patients that received tranexamic acid versus those who received a placebo. While the study found that the tranexamic group had about four extra patients alive out of every 100 patients, the tranexamic arm also had an additional four extra patients with a severe disability at six months. Therefore, the primary endpoint did not show a significant difference. The conclusion of the study was that tranexamic acid appeared to “be associated with lower early mortality but did not result in a higher percentage of patients surviving with a favorable functional outcome at six months than placebo.”
PATCH-Trauma, N.A.T.A.C.T.G., Gruen, R.L., Mitra, B. et al. Prehospital Tranexamic Acid for Severe Trauma. The New England Journal of Medicine, 2023; 389: 127-36.