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Wiese JGG, van Hoving DJ, Hunter L, et al. Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital. Afr J Emerg Med. 2017;7(2):63-67doi: 10.1016/j.afjem.2017.04.006.
Wiese, J. G. G., van Hoving, D. J., Hunter, L., Lahri, S., & Bruijns, S. R. (2017). Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital. African journal of emergency medicine : Revue africaine de la medecine d'urgence, 7(2), 63-67. https://doi.org/10.1016/j.afjem.2017.04.006
Wiese, Jacobus G G, et al. "Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital." African journal of emergency medicine : Revue africaine de la medecine d'urgence vol. 7,2 (2017): 63-67. doi: https://doi.org/10.1016/j.afjem.2017.04.006
Wiese JGG, van Hoving DJ, Hunter L, Lahri S, Bruijns SR. Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital. Afr J Emerg Med. 2017 Jun;7(2):63-67. doi: 10.1016/j.afjem.2017.04.006. Epub 2017 Apr 19. PMID: 30456110; PMCID: PMC6234154.
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Afr J Emerg Med. 2017 Jun;7(2):63-67. doi: 10.1016/j.afjem.2017.04.006. Epub 2017 Apr 19.

Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital.

African journal of emergency medicine : Revue africaine de la medecine d'urgence

Jacobus G G Wiese, Daniël J van Hoving, Luke Hunter, Sa'ad Lahri, Stevan R Bruijns

Affiliations

  1. Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
  2. Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
  3. Khayelitsha Hospital, Khayelitsha, Cape Town, South Africa.

PMID: 30456110 PMCID: PMC6234154 DOI: 10.1016/j.afjem.2017.04.006

Abstract

INTRODUCTION: In South Africa's high injury prevalent setting, it is imperative that injury mortality is kept to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance.

METHODS: A retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was done. A sample of 301 patients was randomly selected from Khayelitsha's resuscitation database and data were supplemented through chart review. The primary endpoint was compliance with local guidance: systolic blood pressure <90 or heart rate >110 or a significant risk of haemorrhage. Injury Severity Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and ISS <8 as low risk. Linear regression and Fischer's Exact test were used to explore assumptions.

RESULTS: Overall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none received a follow-up infusion. Compliance with the protocol was significantly better if an indication for TXA did not exist, compared to when one did (p < 0.001). Increased TXA use was associated only with ISS >15 (p < 0.001).

DISCUSSION: TXA is not used in accordance with local guidelines. It was as likely not to be used when indicated than when not indicated. Reasons for this are multifactorial and likely include stock levels, lack of administration equipment, time to reach definitive care, poor documentation and hesitancy to use. Further investigation is needed to understand the barriers to administration.

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