EBQ:MATTERs Study

Under Review Journal Club Article

Morrison J. et al. "Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study". JAMA Surgery. 2012. 147(2):113-119.
PubMed Full text PDF

Clinical Question

Does administration of Tranexamic (TXA) acid in trauma patients with hemorrhage improve mortality in a wartime setting?

Conclusion

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

Major Points

Similar to the CRASH-2 Trial, the MATTERs Study assessed the outcomes of trauma patients who received Tranexamic acid (TXA). However, unlike CRASH-2, which was a randomized controlled trial, MATTERs was a retrospective observational study of trauma patients at Camp Bastion, a British military base between Jan 1, 2009 an Dec 31, 2010. Only patients who received a transfusion were flagged for review in the retrospective analysis. During the two year period, for the 1st year, TXA was administered at the discretion of the surgeon or anesthetist on the basis of clinical judgment or if herperfibrinolysis was demonstrated. For the second year TXA was part of a major hemorrhage protocol.

In addition to the administration of TXA (IV bolus of 1g with repeat dosing per clinician) all patients recieved blood transfusions and had similar ratios of PRBC:FFP (1:0.87 in TXA group and 1:0.88 in non-TXA group).

Overall patients who receive TXA in coordination with blood transfusions during resucitation following combat trauma, experience improved survival. The survival benefit is greatest in those requiring massive transfusions.

Study Design

• Retrospective cohort study
• N=896 patients
  • TXA group: 125 patients
  • Non-TXA group: 196 patients
• Time period: January 1, 2009 - December 31, 2010
• Setting: Camp Bastion surgical hospital in southern Afghanistan
• In-hospital followup

Further Reading

CRASH-2 Trial