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Approach to Optimizing Tranexamic Acid Use in Trauma: Potential Utilization of Trauma Phenotypes.

Jotaro Tachino¹, Shunichiro Nakao¹, Hisatake Matsumoto¹

¹Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, The University of Osaka, Suita City, Osaka, Japan.

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|February 16, 2026

Summary

Tranexamic acid (TXA) shows greater benefit for trauma patients with higher mortality risk. Identifying specific patient subgroups through trauma phenotypes can optimize TXA use and improve outcomes.

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Area of Science:

Trauma Care
Pharmacology
Clinical Trials

Background:

Tranexamic acid (TXA) is used to reduce mortality in trauma patients.
Optimal patient selection for TXA administration in trauma remains unclear.
Trauma phenotypes may help identify subgroups benefiting most from TXA.

Purpose of the Study:

To identify trauma subgroups most likely to benefit from TXA.
To integrate systematic evidence mapping with trauma phenotype analysis.
To analyze TXA's association with mortality across trauma phenotypes.

Main Methods:

Systematic search of RCTs evaluating TXA in trauma.
Machine learning-based clustering to derive trauma phenotypes from Japan Trauma Data Bank.
Calculation and visualization of control group mortality and number needed to treat (NNT).

Main Results:

Five RCTs and one phenotype study were included.
Control group mortality in RCTs ranged from 10-21.8%; in-hospital mortality across phenotypes ranged from 3.9-51.4%.
NNT varied inversely with baseline mortality, indicating greater TXA benefit in higher-risk groups.

Conclusions:

TXA is more effective in trauma subgroups with higher baseline mortality.
Phenotype-driven stratification using initial clinical data may optimize TXA administration.
Further research is needed to validate phenotypes for clinical implementation.