Research on the association between physician preference and efficacy of hemostatic drugs use regimen in emergency trauma patients.

BACKGROUND

Emergency trauma bleeding is life-threatening, with significant heterogeneity in clinical hemostatic drug use. Physicians' preferences for tranexamic acid, hemocoagulase and etamsylate are influenced by multiple factors, and exploring the association between these preferences and efficacy is crucial for standardizing medication.

OBJECTIVES

This study aimed to identify factors affecting physicians' preferences for the three hemostatic drugs and analyze their preference-efficacy relationship to provide evidence for clinical guidelines.

METHODS

A multicenter prospective observational study was conducted from January 2021 to January 2025, enrolling 1500 eligible emergency trauma patients (18-65 years old) from 18 hospitals. Data on patients, physicians, drug use, and efficacy were analyzed via SPSS 22.0, with multivariate logistic regression adjusting for 12 confounders.

RESULTS

Hospital level, physicians' years of practice, trauma type, and regional economic level significantly affected drug preferences (p<0.05). Tertiary hospitals and physicians with ≥15 years of experience preferred tranexamic acid; secondary hospitals and less experienced physicians favored etamsylate. Tranexamic acid shortened hemostatic time [(14.5±3.0) min] and reduced blood transfusion; hemocoagulase improved coagulation function; etamsylate was cost-effective. After confounder adjustment, physicians' preference for tranexamic acid was independently associated with better efficacy (OR=3.25, 95% CI: 2.17-4.86, p<0.01).

CONCLUSION

Physicians' hemostatic drug preferences are driven by hospital level, experience, trauma type, and regional economy. Tranexamic acid shows superior efficacy in hemostasis and reducing transfusion, while hemocoagulase excels in improving coagulation function. These findings support optimizing clinical medication strategies for emergency trauma.