Do all trauma patients benefit from tranexamic acid?

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Pharmacology

Background:

• Critically injured trauma patients are at high risk for hemorrhagic death.
• Early administration of tranexamic acid (TXA) is hypothesized to reduce mortality in this population.

Purpose of the Study:

• To test the hypothesis that early routine use of TXA reduces mortality in critically injured trauma intensive care unit patients.
• To identify patient subgroups and conditions where TXA may or may not be beneficial.

Main Methods:

• A retrospective review of 1,217 trauma patients requiring emergency surgery and/or transfusions.
• 150 patients receiving TXA at surgeon discretion were matched to 150 non-TXA patients using propensity scores.
• Patient characteristics included age, sex, TBI, injury mechanism, blood pressure, transfusion needs, and ISS.

Main Results:

• The study population had a 22% mortality rate, with 78% requiring emergency surgery and 97% receiving transfusions.
• TXA administration was associated with higher mortality (27%) compared to no TXA (17%).
• TXA benefit was eliminated in patients requiring >2000 mL PRBCs, SBP <120 mm Hg, or emergency surgery.

Conclusions:

• For the highest injury acuity patients, TXA was associated with increased mortality, irrespective of administration timing.
• Rapid availability of fluids and emergency surgery at the trauma center may negate TXA benefits.
• Further prospective studies are needed to identify conditions that may override TXA benefits.