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Comment & Response
December 2017

Could Tranexamic Acid Bias the Optimal Ratio of Fresh Frozen Plasma to Red Blood Cells During Massive Transfusion?—Reply

Author Affiliations
  • 1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston
  • 2Department of Surgery, Eastern Virginia Medical School, Norfolk
  • 3Department of Pathology and Transfusion Medicine, Massachusetts General Hospital, Boston
JAMA Surg. 2017;152(12):1183-1184. doi:10.1001/jamasurg.2017.2971

In Reply We thank Launey et al for their insightful comments in response to our recently published retrospective analysis of the ratio of fresh frozen plasma to red blood cells during massive transfusions in nontrauma patients.1 As they point out, the use of antifibrinolytic agents, such as tranexemic acid (TXA), is well established in cardiac surgery and has been demonstrated to be safe and effective in trauma patients and during postpartum hemorrhage.2,3 Indeed, TXA is already included in nearly half of all formal massive transfusion policies in the United States.4 Unfortunately, the potential independent effect of TXA on transfusion support was beyond the scope of our study, which focused on fresh frozen plasma to red blood cell ratio and mortality. Therefore, we did not collect information about the use of TXA and agree with Launey et al that it may be a potential confounding factor.

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