Should antifibrinolytics be given in all patients with trauma?

Hemorrhage is the second most important cause of death in patients with trauma, contributing to approximately 30% of trauma-related mortality. Pharmacological prohemostatic agents may be useful adjunctive treatment options in patients with severe blood loss.

Tranexamic acid was evaluated in a large international randomized controlled study in patients with trauma and severe blood loss. The drug was shown to reduce death due to bleeding, provided the treatment was given within 3 h after injury. Tranexamic acid treatment did not result in serious adverse events nor thrombotic complications.

In view of this efficacy and safety of this relatively cheap and simple drug, it may be recommended to put tranexamic acid in the first (maybe even prehospital) line of management of patients with severe traumatic hemorrhage.