Intravenous Versus Intraosseous Use of Tranexamic Acid in Patients With Traumatic Brain Injury

Area of Science:

• Emergency Medicine
• Pharmacology
• Trauma Surgery

Background:

• Tranexamic acid (TXA) reduces mortality in traumatic brain injury (TBI) and intracranial hemorrhage.
• Intravenous (IV) access for TXA can be challenging in prehospital settings.
• Intraosseous (IO) access offers a rapid alternative for drug delivery.

Purpose of the Study:

• To compare total drug exposure of TXA administered via IO versus IV routes in patients with moderate to severe brain injury.
• To evaluate the feasibility of IO TXA administration in prehospital settings.

Main Methods:

• Retrospective analysis of prospectively collected data from the prehospital TXA for TBI trial.
• Comparison of TXA pharmacokinetics (AUC) between IO and IV administration groups.
• Stratification by renal function using Kidney Disease Improving Global Outcomes criteria.

Main Results:

• No significant difference in mean area under the plasma drug concentration-time curve (AUC) between IO and IV TXA groups for both 2-g bolus and 1-g bolus/1-g infusion regimens.
• Participant demographics and baseline characteristics were similar between IO and IV groups.
• Preliminary data indicate comparable total drug exposure regardless of administration route.

Conclusions:

• TXA administration via IO and IV routes may result in similar total drug exposure in TBI patients.
• IO access is a potential alternative for prehospital TXA delivery when IV access is not feasible.
• Further research with larger cohorts and clinical outcomes is warranted to confirm these findings.