Tag: trauma

Categories : Injury & TraumaTags :

Positive Safety Evaluation for Tranexamic Acid

On By ModernMedia

A large meta-analysis upheld the safety of tranexamic acid (TXA), even at higher doses.

TXA is an antifibrinolytic agent with a short half-life that is used for bleeding prevention and treatment, as in causes of trauma with open wounds. Current TXA is applied with caution due to perceived increased risk of seizures, MI, and other thrombotic complications.

The meta-analysis looked at 216 randomised trials involving 125 550 participants. The investigators found that the incidence of thromboembolic events, which included venous thrombosis, pulmonary embolism, venous thromboembolism, myocardial infarction (MI) or ischaemia, and cerebral infarction or ischaemia, was 2.1% of people receiving IV TXA and a similar 2.0% of peers getting placebo or another control, which was a non-significant difference.

TXA’s safety was inconclusive in those with neurological conditions, who showed increased heterogeneity and asymmetry in funnel plots, according to Patrick Meybohm, MD, of University Hospital Wuerzburg in Germany, and colleagues.

The review confirmed that TXA was linked to a significant reduction in overall mortality and bleeding mortality, but not nonbleeding mortality.

“The results of this study suggest that use of intravenous TXA may have utility in all medical fields, with some uncertainty for patients with neurological conditions,” the investigators concluded.

“Notably, we did not detect any dose-dependent association of TEs [thromboembolic events],” they stated. The included studies had participants with IV TXA administration at doses ranging 0.5-5g or 10-100mg/kg.

“There is little doubt that when used appropriately in the various patient populations evaluated with randomized clinical trials, TXA is effective. However, reasonable questions about thrombotic complications remain,” wrote John Holcomb, MD, of University of Alabama at Birmingham, and colleagues, in an invited commentary.

“Further research must focus on how to identify, as early as possible, the patients most likely to benefit from administration of TXA,” they urged.

One limitation mentioned by the investigators was the inclusion trials that evaluated thromboembolic events without ultrasound, so asymptomatic cases may have been excluded. Furthermore, many studies did not provide much information on thrombosis prophylaxis.

For Holcomb’s group, study’s main caveat was that it included “a notably heterogeneous population”, including a range of demographics and clinical conditions. Since the pooled studies were not “clinically homogeneous”, they violated “one of the cardinal tenets of systematic reviews and meta-analyses.”

Source: MedPage Today

Journal information (primary article): Taeuber I, et al “Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression” JAMA Surg 2021; DOI: 10.1001/jamasurg.2021.0884.

Journal information (commentary): Holcomb JB, et al “Tranexamic acid and safety in the right patient” JAMA Surg 2021; DOI: 10.1001/jamasurg.2021.0929.

Categories : COVID General InterestTags :

Liquor Industry Questions Alcohol Ban Effectiveness

On By ModernMedia

Representatives from the liquor industry have said that the South African government must consider data from a new report that shows little alcohol ban effectiveness on trauma cases. However, other studies show negative effects of alcohol during lockdown, and a surge in violent trauma in Cape Town after alcohol bans were lifted.

In a statement on Thursday, the South African Liquor Brand owners Association (Salba) referenced a new report showing that, compared to other countries, South Africa saw similar trauma cases with its lockdown and alcohol ban to those that only had a lockdown.

The report had financial support from Distell, led by independent data expert Ian McGorian of Silver Fox Consulting, in collaboration with professor Mike Murray from the University of KwaZulu-Natal.

The report found that trauma cases in South Africa under lockdown dropped 60%. But other countries also saw the same drop with no alcohol ban, including the UK (57%), Ireland (62%), Italy (56.6%) and the USA (54%), casting doubt over the effectiveness of alcohol bans in curbing trauma. The researchers also commented that curfews may have explained more of a reduction in trauma cases than alcohol bans.

While members of the liquor industry recognised the impact of alcohol on South African society, they said that government needs to be more objective with its lockdown regulations.

Salba chairperson Sibani Mngadi said the alcohol ban over Easter Weekend, while simultaneously allowing larger gatherings, made even less sense in reducing COVID transmission. This suggests that government was not considering science in its decision making, he said.

However, a multicentre study from Colorado, USA showed that even while trauma cases during lockdown fell by 33%, alcohol screens increased from 34% to 37%, and alcohol positive patients rose from 32% to 39%.

A study of Cape Town trauma admissions saw a dramatic drop of 53% in trauma admissions during the hard lockdown and an immediate rebound coinciding with the resumption of alcohol sales, with a 107% increase in gunshots wounds compared to pre-lockdown conditions.

The researchers noted that in South Africa the trauma demographic is much younger, with much higher rates of violence, with about half of homicide victims in SA testing positive for alcohol.

Distell chief executive Richard Rushton said the industry was merely asking that the data should be viewed objectively to improve dialogue with decision makers.

“We are all on the same side, and we want to help find solutions. We are very clear that alcohol abuse is unacceptable and causes harm. Our view is that the focus must be on finding ways to deal with high-risk drinkers, rather than using blunt instruments that penalise all South Africans.

“Any proposed new regulations need to be evidence-based, rational and target problem areas,” he said.

Business Leadership SA chief executive Busisiwe Mavuso said that lockdown could have been better managed, as 220 000 jobs had been lost along billions of rands in tax to the fiscus, while uncertainty still plagued alcohol producers.

“The decisions made to confront the health crisis should not have unintended consequences for the economy, and that is exactly what has happened with the bans on alcohol,” she said.

Mr Mavuso added that, since the start of the pandemic, business has been a willing partner to government and “needs to be part of the solution to ensure we fight this pandemic with the least possible damage to the economy”.

“The data analysis by the alcohol industry is an important intervention and must be taken seriously as we move forward.”

Source: BusinessTech