Cryoprecipitate plus tranexamic acid boost war injury survival

By Lynda Williams, Senior medwireNews Reporter

Administration of cryoprecipitate and tranexamic acid significantly improves the likelihood of survival among seriously injured patients requiring packed red blood cells, suggest results from MATTERS II.

Combatants treated at a hospital in Afghanistan who were given tranexamic acid alone (n=148) or with cryoprecipitate (n=258) had lower in-hospital mortality rates than patients treated with cryoprecipitate alone (n=168) or with neither agent (n=758), at 11.6%, 18.2%, 21.4%, and 23.6%, respectively.

This greater survival occurred despite patients treated with tranexamic acid and cryoprecipitate having greater Injury Severity Scores than other patients, and requiring four times the amount of packed red blood cell transfusions, plasma, and platelets than those given neither tranexamic acid nor cryoprecipitate, the researchers note.

Indeed, in propensity analysis, receipt of tranexamic acid and cryoprecipitate were both independently predictive of a reduced risk for mortality, each with an odds ratio of 0.61, compared with transfusion alone. When treatment was combined in a synergy model, tranexamic acid plus cryoprecipitate had an odds ratio of 0.34 for survival compared with no treatment, although this was not significant.

The MATTERS (Military Application of Tranexamic Acid in Trauma Emergency Resuscitation) II study follows on from the demonstration of the benefit of tranexamic acid after wartime injury in MATTERS I. Previous research has also indicated that treating severely injured patients with antifibrinolytics significantly reduces mortality and that early administration of fibrogen-rich cryoprecipitate may boost survival.

"The effect of cryoprecipitate appears to be additive to that of tranexamic acid, suggesting that repletion of fibrinogen may be as important as preventing its degradation in this setting," report Todd Rasmussen (US Army Institute of Surgical Research, San Antonio, Texas, USA) and co-authors.

Although the benefit of cryoprecipitate is thought to be fibrinogen-related, the researchers admit that it contains other compounds, such as von Willebrand factor or factor VIII, which may also provide benefit to patients.

"This study provides new data showing a survival benefit with the use of cryoprecipitate and tranexamic acid in the setting of trauma and provides a foundation for detailed study of these compounds including prospective trials of fibrinogen concentrate," they conclude.

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