After an injury, the major cause of mortality is bleeding. Treatment with tranexamic acid (TXA) lowers bleeding fatalities and mortality from all causes without increasing the risk of thrombotic adverse events. However, it is unknown which trauma victims would benefit from TXA therapy. Some publications advocate the judicious use of TXA based on the severity of the damage and the findings of viscoelastic haemostatic testing (VHA). Recent publications have examined the impact of TXA therapy on severely wounded and non-severely injured trauma patients using data from large randomized trials.

The authors performed a meta-analysis of individual patient data from randomized trials including over 1000 trauma victims to determine the impact of TXA on survival. Authors determined the severity of damage based on first assessment characteristics: systolic blood pressure of less than 90 mm Hg and a heart rate of more than 120 beats per minute, or a Glasgow Coma Scale score of less than nine, or a GCS with one or more fixed dilated pupils. The most important metric was survival on the day of injury. The authors investigated the impact of TXA on survival in severely and non-severely wounded patients, as well as how these effects varied with the length of time between injury and therapy. Two randomized studies yielded data for 32,944 patients, which the authors accessed. Tranexamic acid enhanced survival considerably on the day of injury (OR = 1.22, 95% CI 1.11–1.34; p .01). The impact of tranexamic acid on survival in patients with non-severe injuries (OR = 1.25, 1.03–1.50) was comparable to that in patients with severe injuries (OR = 1.22, 1.09–1.37), with no significant heterogeneity (p =.87). The most successful therapy for both severely and moderately damaged patients occurred during the first hour following injury.
Tranexamic acid increases the survival rate of seriously wounded and non-severely damaged individuals in a safe manner. Limiting the use of tranexamic acid to patients with serious injuries may deprive many trauma victims of a potentially lifesaving, very safe medication. The effectiveness of TXA therapy is greatest when administered within one hour after damage, especially in individuals with less severe injuries. The advantage of early therapy for non-severely wounded patients is equivalent to the preventative impact of TXA during elective surgery. In fact, a significant number of these individuals will have surgery on the day of their accident. New data that TXA is well-tolerated and fast absorbed after intramuscular injection raises the prospect of paramedics or lay responders administering TXA prior to hospitalization.
Reference –
Ageron, F-X, Shakur-Still, H, Roberts, I. Effects of tranexamic acid treatment in severely and non-severely injured trauma patients. Transfusion. 2022; 62( S1): S151– S157. https://doi.org/10.1111/trf.16954