In South Africa’s high injury prevalent setting, it is imperative that injury mortality is kept 21 to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. 22 Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape 23 Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance.

Methods: A retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was 25 done. A sample of 301 patients was randomly selected from Khayelitsha’s resuscitation database and data 26 were supplemented through chart review. The primary endpoint was compliance with local guidance: 27 systolic blood pressure <90 or heart rate >110 or a significant risk of haemorrhage. Injury Severity 28 Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and 29 ISS <8 as low risk. Linear regression and Fischer’s Exact test were used to explore assumptions.

Results: Overall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 31 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none 32 received a follow-up infusion. Compliance with the protocol was significantly better if an indication for 33 TXA did not exist, compared to when one did (p < 0.001). Increased TXA use was associated only with ISS 34>15 (p < 0.001).