Use of tranexamic acid in major trauma: sex-disaggragated analysis of trials & UK trauma clinics, 2022, Nutbeam et al

JohnTheJack · May 20, 2022

Full title:

Use of tranexamic acid in major trauma: a sex-disaggragated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials and UK trauma registry (Trauma and Audit Research Network) data

https://www.bjanaesthesia.org/article/S0007-0912(22)00184-2/fulltext

Abstract

Background
Women are less likely than men to receive some emergency treatments. This study examines whether the effect of tranexamic acid (TXA) on mortality in trauma patients varies by sex and whether the receipt of TXA by trauma patients varies by sex.

Methods
First, we conducted a sex-disaggregated analysis of data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH)-2 and CRASH-3 trials. We used interaction tests to determine whether the treatment effect varied by sex.

Second, we examined data from the Trauma and Audit Research Network (TARN) to explore sex differences in the receipt of TXA. We used logistic regression models to estimate the odds ratio for receipt of TXA in females compared with males. Results are reported as n (%), risk ratios (RR), and odds ratios (OR) with 95% confidence intervals.

Results
Overall, 20 211 polytrauma patients (CRASH-2) and 12 737 patients with traumatic brain injuries (CRASH-3) were included in our analysis. TXA reduced the risk of death in females (RR=0.69 [0.52–0.91]) and in males (RR=0.80 [0.71–0.90]) with no significant heterogeneity by sex (P=0.34). We examined TARN data for 216 364 patients aged ≥16 yr with an Injury Severity Score ≥9 with 98 879 (46%) females and 117 485 (54%) males. TXA was received by 7198 (7.3% [7.1–7.4%]) of the females and 19 697 (16.8% [16.6–17.0%]) of the males (OR=0.39 [0.38–0.40]). The sex difference in the receipt of TXA increased with increasing age.

Conclusions
Administration of TXA to patients with bleeding trauma reduces mortality to a similar extent in women and men, but women are substantially less likely to be treated with TXA.
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Use of tranexamic acid in major trauma: sex-disaggragated analysis of trials & UK trauma clinics, 2022, Nutbeam et al

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Use of tranexamic acid in major trauma: sex-disaggragated analysis of trials & UK trauma clinics, 2022, Nutbeam et al

JohnTheJack Moderator Staff Member

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