Tranexamic acid and trauma-induced coagulopathy

Area of Science:

• Pharmacology
• Trauma Medicine
• Critical Care

Background:

• Tranexamic acid (TXA), a lysine derivative, inhibits fibrinolysis.
• TXA is established for perioperative bleeding reduction and increasingly used in trauma.
• The CRASH-2 trial (2010) showed TXA improved mortality in bleeding trauma patients, altering global treatment protocols.

Purpose of the Study:

• To review current evidence and guidelines for TXA in trauma.
• To analyze the benefits and harms of TXA in trauma patients.
• To assess the safety of TXA by systematically reviewing observational studies on adverse events.

Main Methods:

• Systematic review of observational studies.
• Meta-analysis of venous thromboembolism (VTE) risk.
• Literature review of current guidelines and evidence.

Main Results:

• Pooled relative risk for VTE with TXA was 1.61 (non-significant increase).
• TXA administration is now a mainstream trauma treatment protocol globally.
• Discussion continues regarding TXA's adverse events, particularly vascular occlusive events.

Conclusions:

• TXA has a potential risk of VTE and should be used cautiously and selectively.
• Further research is needed to identify optimal trauma patient subgroups for TXA therapy.
• Maximizing survival benefits while minimizing thrombotic complications is the goal for TXA use.