Tranexamic Acid Timing and Mortality Impact After Trauma.

Area of Science:

• Trauma resuscitation
• Emergency medicine
• Pharmacology

Background:

• Current trauma resuscitation guidelines recommend tranexamic acid (TXA) within 3 hours of injury, based on CRASH-2 trial data.
• This 3-hour window has not been independently replicated, prompting further investigation into optimal timing.

Purpose of the Study:

• To determine if 28-day mortality after trauma varies with the time to the first TXA dose.
• To precisely define the therapeutic window for TXA administration in major trauma patients.

Main Methods:

• Exploratory analysis of the PATCH-Trauma trial involving adults with major trauma and suspected coagulopathy.
• Patients received either TXA or placebo; time from injury to first TXA dose was analyzed using continuous functions.
• Log-binomial regression was used to assess mortality risk within 28 days based on treatment timing.

Main Results:

• The study included 1,287 patients; median time to first TXA dose was 79 minutes.
• Mortality risk increased with delayed TXA administration, with benefits most pronounced up to 90 minutes post-injury.
• TXA administration within 90 minutes significantly reduced 28-day mortality (aRR 0.64), while administration after 90 minutes showed no significant benefit (aRR 1.04).

Conclusions:

• The optimal therapeutic window for administering TXA in trauma patients appears to be within 90 minutes of injury.
• This finding suggests a narrower, more critical window for TXA efficacy than previously established.