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Prehospital Tranexamic Acid and First 24-Hour Blood Product Transfusion in Patients with Isolated Traumatic Brain
Zachary C Newman1, W Ian McKinley2, Rachel K Nordgren3
1From The University of Chicago Pritzker School of Medicine, Chicago, IL (Newman, Deshpande).
Journal of the American College of Surgeons
|April 4, 2025
Summary
Prehospital tranexamic acid (TXA) may reduce red blood cell transfusions in isolated traumatic brain injury (iTBI) patients. Further analysis suggests this effect might be influenced by injury type and the need for neurosurgery.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Neurocritical Care
Background:
- Tranexamic acid (TXA) is an antifibrinolytic used in trauma, but its effect on blood product use in traumatic brain injury (TBI) is unclear.
- Existing evidence on TXA's impact on transfusion in bleeding trauma patients is conflicting.
Purpose of the Study:
- To investigate the association between prehospital TXA administration and red blood cell transfusion in patients with isolated traumatic brain injury (iTBI).
Main Methods:
- Secondary analysis of the prehospital TXA for TBI trial.
- Included patients with iTBI (GCS 3-12, no shock) treated within 2 hours of injury.
- Logistic regression used to identify factors associated with transfusion.
Main Results:
- 306 iTBI patients were analyzed across TXA and placebo groups.
- Receipt of 1-g TXA bolus or infusion was associated with significantly decreased odds of red cell transfusion (OR 0.27, p=0.03).
- Overall TXA administration showed reduced odds of red cell transfusion (OR 0.32, p=0.02).
Conclusions:
- Prehospital TXA may be associated with lower odds of red cell transfusion in iTBI patients compared to placebo.
- Treatment group imbalances in penetrating injury mechanisms and need for neurosurgery may have mediated this effect.
