EBQ:MATTERs Study - Revision history

Drtldelt: there was a typo

2015-08-31T12:43:23Z

there was a typo

← Older revision		Revision as of 12:43, 31 August 2015
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	==Major Points==		==Major Points==
	Similar to the [[EBQ:CRASH-2_Trial\|CRASH-2 Trial]], the MATTERs Study assessed the outcomes of trauma patients who received Tranexamic acid (TXA). However, unlike [[EBQ:CRASH-2_Trial\|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.		Similar to the [[EBQ:CRASH-2_Trial\|CRASH-2 Trial]], the MATTERs Study assessed the outcomes of trauma patients who received Tranexamic acid (TXA). However, unlike [[EBQ:CRASH-2_Trial\|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 hyperfibrinolysis 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).		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).

Ostermayer at 17:24, 29 March 2014

2014-03-29T17:24:04Z

← Older revision		Revision as of 17:24, 29 March 2014
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	\| fulltexturl= http://archsurg.jamanetwork.com/article.aspx?articleid=1107351		\| fulltexturl= http://archsurg.jamanetwork.com/article.aspx?articleid=1107351
	\| pdfurl= http://archsurg.jamanetwork.com/data/Journals/SURG/22581/siz110024_113_119.pdf		\| pdfurl= http://archsurg.jamanetwork.com/data/Journals/SURG/22581/siz110024_113_119.pdf
	\| status =~~Completed~~		\| status =Complete
	}}		}}

Ostermayer at 17:23, 29 March 2014

2014-03-29T17:23:55Z

← Older revision		Revision as of 17:23, 29 March 2014
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	\| fulltexturl= http://archsurg.jamanetwork.com/article.aspx?articleid=1107351		\| fulltexturl= http://archsurg.jamanetwork.com/article.aspx?articleid=1107351
	\| pdfurl= http://archsurg.jamanetwork.com/data/Journals/SURG/22581/siz110024_113_119.pdf		\| pdfurl= http://archsurg.jamanetwork.com/data/Journals/SURG/22581/siz110024_113_119.pdf
	\| status =~~Under Review~~		\| status =Completed
	}}		}}

Ostermayer: /* Primary Outcomes */

2014-03-29T17:22:51Z

Primary Outcomes

← Older revision		Revision as of 17:22, 29 March 2014
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	==Outcome==		==Outcome==
	===Primary Outcomes===		===Primary Outcomes===
	'''Overall TXA vs. Non-TXA'''		'''Overall TXA vs. Non-TXA'''
	{\|class="wikitable"		{\|class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''Mortality'''		\| align="center" style="background:#f0f0f0;"\|'''Mortality'''
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	\| In Hospital Mortality\|\|17.40%\|\|23.90%\|\|0.03		\| In Hospital Mortality\|\|17.40%\|\|23.90%\|\|0.03
	\|}		\|}



	===Secondary Outcomes===		===Secondary Outcomes===

Ostermayer: Ostermayer moved page EBQ:MATTERs to EBQ:MATTERs Study

2014-03-29T17:19:36Z

Ostermayer moved page EBQ:MATTERs to EBQ:MATTERs Study

← Older revision	Revision as of 17:19, 29 March 2014
(No difference)

Ostermayer: /* Criticisms */

2014-03-29T17:18:36Z

Criticisms

← Older revision		Revision as of 17:18, 29 March 2014
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	==Criticisms==		==Criticisms==
			*For the first year of the study there was no clear protocol for administration of TXA to patients and was under discretion of the treating physician, which potentially introduces a selection bias.
			*The MATTERs study offers much more insight into the mortality risk of bleeding patients than did the [[EBQ:CRASH-2 Trial\|CRASH-2 Trial]] since everyone in MATTERs received a transfusion. However this was a single center military trauma hospital and the treatment setting may not be generalizable to all trauma centers.
			*Although some patients were treated on the basis of the degree of fibrinolysis there was not quantitative degree or response to treatment demonstrated as well as no information provided regarding timing of TXA administration.<ref>Kenji Inaba. Antifibrinolytics in Trauma Patients: Does It MATTER? Comment on “Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study” Arch Surg. 2012;147(2):119</ref>
			*The addition of cryoprecipitate to the resuscitation efforts may independently add to the survival benefit of tranexamic acid in the seriously injured requiring transfusion<ref>Morrison J et al. Association of Cryoprecipitate and Tranexamic Acid With Improved Survival Following Wartime InjuryFindings From the MATTERs II Study. JAMA Surg. 2013;148(3):218-225 [http://archsurg.jamanetwork.com/data/Journals/SURG/926616/soa120074_218_225.pdf PDF]</ref>

	==Funding==		==Funding==

Ostermayer: /* Funding */

2014-03-29T17:03:11Z

Funding

← Older revision		Revision as of 17:03, 29 March 2014
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	==Funding==		==Funding==
			The study was supported by the Office of the US Air Force Surgeon General and was created in the performance of a contract with the Air Force Medical Support Agency.

	==Further Reading==		==Further Reading==
	[[EBQ:CRASH-2_Trial \| CRASH-2 Trial]]		[[EBQ:CRASH-2_Trial \| CRASH-2 Trial]]

Ostermayer: /* Outcome */

2014-03-29T17:01:56Z

Outcome

@@ Line 58: / Line 58: @@
 ==Outcome==
+===Primary Outcomes===
 ===Secondary Outcomes===
+'''TXA vs Non-TXA (Massive Transfusion subgroup) '''

Ostermayer: /* Outcome */

2014-03-29T16:12:51Z

Outcome

← Older revision		Revision as of 16:12, 29 March 2014
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	**Non-TXA: 2		**Non-TXA: 2
	*Deep Venous Thrombosis:		*Deep Venous Thrombosis:
	**TXA 7		**TXA: 7
	**Non-TXA:1		**Non-TXA: 1

	==Criticisms==		==Criticisms==

Ostermayer: /* Interventions */

2014-03-29T16:12:32Z

Interventions

← Older revision		Revision as of 16:12, 29 March 2014
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	*Injury Severity Score: 23.9		*Injury Severity Score: 23.9

	==Interventions==		==Interventions==
			*1gm TXA IV bolus (with re-dosing at provider discretion)
			*Massive transfusion transfusion patients were defined as receiving 10+ units PRBC within 24hrs

	==Outcome==		==Outcome==