Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

Shah Jahan Mohd Yussof; Shamila Mohamad Ali; Nurul Azlean Norzan; Mohd Amin Mohidin; Anandakumar Krishnan; Ahmad Ibrahim Kamal Batcha; Ahmad Tajuddin Mohamad Nor; Aik Howe Teo; Mohamed Saed Mian; Fatahul Laham Mohamed; Ridzuan Mohd Isa; Mohd Idzwan Zakaria; Mohd Khairizam Mohd Yusoff; Joseph Mathew; Mark Fitzgerald; Sabariah Faizah Jamaluddin; Kiat Kee Gan

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Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

Author: Shah Jahan Mohd Yussof ¹ ; Shamila Mohamad Ali ² ; Nurul Azlean Norzan ³ ; Mohd Amin Mohidin ⁴ ; Anandakumar Krishnan ⁵ ; Ahmad Ibrahim Kamal Batcha ¹ ; Ahmad Tajuddin Mohamad Nor ⁶ ; Aik Howe Teo ⁷ ; Mohamed Saed Mian ⁴ ; Fatahul Laham Mohamed ⁸ ; Ridzuan Mohd Isa ² ; Mohd Idzwan Zakaria ⁹ ; Mohd Khairizam Mohd Yusoff ⁵ ; Joseph Mathew ¹⁰ ; Mark Fitzgerald ¹⁰ ; Sabariah Faizah Jamaluddin ¹¹ ; Kiat Kee Gan ⁴
Author Information

1. Emergency Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
2. Emergency Department, Hospital Ampang, Ampang, Selangor, Malaysia
3. 3 Emergency Department, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
4. Emergency Department, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
5. Emergency Department, Hospital Banting, Banting, Selangor, Malaysia
6. Emergency Department, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
7. Emergency Department, Hospital Pulau Pinang, Pulau Pinang, Malaysia
8. Emergency Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
9. University Malaya Medical Center, Kuala Lumpur, Malaysia
10. Trauma Services, The Alfred, Melbourne, Australia
11. Emergency Department, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
Publication Type:Journal Article
Keywords: Hemorrhage Control; CRASH 2; PATCH-Study; Trauma Management; Emergency Medicine
From: The Medical Journal of Malaysia 2019;74(4):300-306
CountryMalaysia
Language:English
Abstract: Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.
Full text:6.2019.my1439.pdf