{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T20:12:21Z","timestamp":1784146341389,"version":"3.55.0"},"reference-count":29,"publisher":"California Digital Library (CDL)","issue":"2","license":[{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["WestJEM"],"abstract":"<jats:p>Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.\n\nMethods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS &gt;15), (2) those who sustained significant blood loss (\u226510 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.\n\nResults: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS&gt;15, patients transfused with \u226510 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS&gt;15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS&gt;15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0). \n\nConclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock.<\/jats:p>","DOI":"10.5811\/westjem.2019.10.43055","type":"journal-article","created":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T22:13:25Z","timestamp":1583792005000},"page":"217-225","source":"Crossref","is-referenced-by-count":13,"title":["Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation"],"prefix":"10.5811","volume":"21","author":[{"given":"Michael","family":"Neeki","sequence":"first","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California California University of Science and Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanglong","family":"Dong","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Toy","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Salameh","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massoud","family":"Rabiei","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe","family":"Powell","sequence":"additional","affiliation":[{"name":"City of Rialto Fire Department, Rialto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Vara","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Inaba","sequence":"additional","affiliation":[{"name":"Univeristy of Southern California, Department of Surgery, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wong","sequence":"additional","affiliation":[{"name":"California University of Science and Medicine, Colton, California Arrowhead Regional Medical Center, Department of Surgery, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Comunale","sequence":"additional","affiliation":[{"name":"California University of Science and Medicine, Colton, California Arrowhead Regional Medical Center, Department of Anesthesia, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Lowe","sequence":"additional","affiliation":[{"name":"California University of Science and Medicine, Colton, California Arrowhead Regional Medical Center, Department of Pharmacy, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Chandwani","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California California University of Science and Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Quispe","sequence":"additional","affiliation":[{"name":"Loma Linda University Medical Center, Department of General Surgery, Loma Linda, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Borger","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California California University of Science and Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2020,2,21]]},"reference":[{"key":"ref0","unstructured":"Centers for Disease Control and Prevention. 2015, United States  All Injury Deaths and Rates per 100,000  All Races, Both Sexes, Ages 18 to 85+. Available at: https:\/\/webappa.cdc.gov\/cgi-bin\/broker.exe. Accessed 27 Dec, 2017."},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Heckbert SR, Vedder NB, Hoffman W, et al. Outcome after hemorrhagic shock in trauma patients. J Trauma. 1998;45(3):545-9.","DOI":"10.1097\/00005373-199809000-00022"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54(6):1127-30.","DOI":"10.1097\/01.ta.0000069184.82147.06"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"MacLeod JB, Lynn M, McKenney MG, et al. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55(1):39-44.","DOI":"10.1097\/01.TA.0000075338.21177.EF"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Niles SE, McLaughlin DF, Perkins JG, et al. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma. 2008;64(6):1459-63; discussion 1463-5.","DOI":"10.1097\/ta.0b013e318174e8bc"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Theusinger OM, Baulig W, Seifert B, et al. Changes in coagulation in standard laboratory tests and ROTEM in trauma patients between on-scene and arrival in the emergency department. Anesth Analg. 2015;120(3):627-35.","DOI":"10.1213\/ane.0000000000000561"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Moore HB, Moore EE, Gonzalez E, et al. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg. 2014;77(6):811-7; discussion 817.","DOI":"10.1097\/ta.0000000000000341"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Raza I, Davenport R, Rourke C, et al. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost. 2013;11(2):307-14.","DOI":"10.1111\/jth.12078"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57(6):1005-1032.","DOI":"10.2165\/00003495-199957060-00017"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Wafaisade A, Lefering R, Bouillon B, et al. Prehospital administration of tranexamic acid in trauma patients. Crit Care. 2016;20(1):143.","DOI":"10.1186\/s13054-016-1322-5"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Neeki MM, Dong F, Toy J, et al. Efficacy and safety of tranexamic acid in prehospital traumatic hemorrhagic shock: outcomes of the Cal-PAT study. West J Emerg Med. 2017;18(4):673-83.","DOI":"10.5811\/westjem.2017.2.32044"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32.","DOI":"10.1016\/s0140-6736(10)60835-5"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-1101, 1101.e1-2.","DOI":"10.1016\/s0140-6736(11)60278-x"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Morrison JJ, Dubose JJ, Rasmussen TE, et al. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147(2):113-9.","DOI":"10.1001\/archsurg.2011.287"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Cole E, Davenport R, Willett K, et al. Tranexamic acid use in severely injured civilian patients and the effects on outcomes: a prospective cohort study. Ann Surg. 2015;261(2):390-4.","DOI":"10.1097\/sla.0000000000000717"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Boutonnet M, Abback P, Le Sache F, et al. Tranexamic acid in severe trauma patients managed in a mature trauma care system. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S54-62.","DOI":"10.1097\/ta.0000000000001880"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Johnston LR, Rodriguez CJ, Elster EA, et al. Evaluation of military use of tranexamic acid and associated thromboembolic events. JAMA Surg. 2018;153(2):169-75.","DOI":"10.1001\/jamasurg.2017.3821"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Myers SP, Kutcher ME, Rosengart MR, et al. Tranexamic acid administration is associated with an increased risk of post-traumatic venous thromboembolism. J Trauma Acute Care Surg. 2019;86(1):20-7.","DOI":"10.1097\/ta.0000000000002061"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Neeki MM, Dong F, Toy J, et al. Tranexamic acid in civilian trauma care in the California Prehospital Antifibrinolytic Therapy Study. West J Emerg Med. 2018;19(6):977-86.","DOI":"10.5811\/westjem.2018.8.39336"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32.","DOI":"10.1016\/s0140-6736(10)60835-5"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Roberts I, Prieto-Merino D, Manno D. Mechanism of action of tranexamic acid in bleeding trauma patients: an exploratory analysis of data from the CRASH-2 trial. Crit Care. 2014;18(6):685.","DOI":"10.1186\/s13054-014-0685-8"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Davenport RA, Guerreiro M, Frith D, et al. Activated protein C drives the hyperfibrinolysis of acute traumatic coagulopathy. Anesthesiology. 2017;126(1):115-27.","DOI":"10.1097\/aln.0000000000001428"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Rezaie AR. Vitronectin functions as a cofactor for rapid inhibition of activated protein c by plasminogen activator inhibitor-1 implications for the mechanism of profibrinolytic action of activated protein C. J Biol Chem. 2001;276(19):15567-70.","DOI":"10.1074\/jbc.c100123200"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Syrovets T, Lunov O, Simmet T. Plasmin as a proinflammatory cell activator. J Leukoc Biol. 2012;92(3):509-19.","DOI":"10.1189\/jlb.0212056"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Li Q, Laumonnier Y, Syrovets T, et al. Plasmin triggers cytokine induction in human monocyte-derived macrophages. Arterioscler Thromb Vasc Biol. 2007;27(6):1383-9.","DOI":"10.1161\/atvbaha.107.142901"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Meizoso JP, Dudaryk R, Mulder MB, et al. Increased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid. J Trauma Acute Care Surg. 2018;84(3):426-32.","DOI":"10.1097\/ta.0000000000001792"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Valle EJ, Allen CJ, Van Haren RM, et al. Do all trauma patients benefit from tranexamic acid? J Trauma Acute Care Surg. 2014;76(6):1373-8.","DOI":"10.1097\/ta.0000000000000242"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Knudson MM, Ikossi DG, Khaw L, et al. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Ann Surg. 2004;240(3):490-8.","DOI":"10.1097\/01.sla.0000137138.40116.6c"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Napolitano LM, Cohen MJ, Cotton BA, et al. Tranexamic acid in trauma: How should we use it? J Trauma Acute Care Surg. 2013;74(6):1575-86.","DOI":"10.1097\/ta.0b013e318292cc54"}],"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T22:26:14Z","timestamp":1583792774000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/7nd9r2rt"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,21]]},"references-count":29,"issue-title":["WestJEM 21.2 March Issue"],"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,3,2]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.2019.10.43055","relation":{},"ISSN":["1936-900X"],"issn-type":[{"value":"1936-900X","type":"print"}],"subject":[],"published":{"date-parts":[[2020,2,21]]}}}