Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study

## Jonathan J. Morrison, MB ChB, MRCS; Joseph J. Dubose, MD; Todd E. Rasmussen, MD; Mark J. Midwinter, BMedSci, MD, FRCS

Archives of Surgery 2012;147(2):113-119.

#### Description with Key Points:

The purpose of this study was to characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. This was a retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (greater than 10 units of packed red blood cells) was also examined.

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A total of 896 consecutive combat injury admissions to a Role 3 Echelon surgical hospital in southern Afghanistan were evaluated (of the 896 injured patients, 293 received TXA). Outcome measures included mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications.

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The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively) despite being more severely injured. This benefit was greatest in the group of patients who received massive transfusion , where TXA was also independently associated with survival and less coagulopathy.

Key Figure:
Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study
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# Take Home Message:

Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
The use of TXA with blood component based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion.
TXA helps stop the bleeding.
TXA helps prevent death from hemorrhage.