Results of tranexamic acid use in multiple trauma patients of Akdeniz University Hospital emergency department

Introduction and Aim: Every year, approximately three million people die as a result of trauma, mostly after reaching the hospital. When the mortality results due to multiple trauma are examined, it is seen that hemorrhagic shock is in the first place. Tranexamic Acid (TXA), one of the antifibrinolytic agents, was the first therapeutic agent whose survival efficiency was demonstrated in multiple trauma patients accompanied by hemorrhagic shock, with the CRASH-II study published in 2013. Treatment rules were determined in the Advanced Trauma Life Support (ATLS) guide updated in September 2018, which is widely used in the world, and added to the guide. As it is known, changes in the guideline are reflected in the field applications late in the world and in all branches. The aim of this thesis study is to determine the frequency of "tranexamic acid" (transamin®) use and compliance with the guideline in patients with multiple system trauma who applied directly to the Akdeniz University Hospital Emergency Department or brought by the 112 Ambulance system following the ATLS guideline 2018 update, and to show its effects on mortality, vascular occlusive events (deep vein thrombosis, myocardial infarction, pulmonary embolism, stroke), need for surgery and need for blood transfusion in patients receiving treatment. Materials and Methods: This cross-sectional study was conducted as a single center, covering multi-system trauma patients brought to the Emergency Department of Akdeniz University Hospital between September 2018 and August 2020, either directly or by the 112 Ambulance system. Using the hospital information management system, e-Nabız and Death Notification System, the data of the patients were accessed, and the SPSS program was used in the analysis of the obtained data. Results: A total of 326 patients who met the inclusion criteria and whose data were fully accessible were included in the analysis. 81% of the patients are male and the mean age is 42.28 years. 91.4% of the patients are "blunt traumas", 82.23% of them are "normotensive" patients and 66.3% of them are patients with a GCS score between 13-15. Within one month, 66 (20.2%) patients included in the study died, 170 (52.1%) patients needed surgery, and 194 (59.5%) patients needed blood and blood product transfusion. Three emergency medicine research assistants, who had worked in the emergency department of our hospital for more than 3 years, independently screened the patients included in the study for TXA indication, in accordance with the objectives of the CRASH-II study. It was observed that 98 (56.64%) of the patients with this TXA indication were not administered TXA, and 75 (43.35%) of them were administered TXA. The basic comparison was made between patients who were "treated for TXA indication" and patients for "TXA indicated but not treated". Mortality, need for blood and blood product transfusion, need for surgery, development of vasoocclusive events, causes of death, types of surgery, systolic blood pressures and GCS scores within 30 days between these two groups were compared. Conclusion: It was found that physicians generally do not skip the use of TXA in patients with thoracic and abdominal injuries, but they often overlook the use of TXA in patients with orthopedic injuries and TXA indication. Increasing the awareness of physicians on this issue may result in a significant reduction in mortality. TXA can be used without hesitation in the management of trauma patients due to its cheapness, lack of serious side-effect profile and ease of use.