Role of Tranexamic Acid in Orthopedic Trauma: Current Evidence, Clinical Applications, and Ongoing Controversies

The worldwide burden of traumatic injuries is increasing daily due to industrial and mechanical development. Traumatic injuries often lead to hemorrhage, which is a major contributor to illness and death in cases of orthopedic trauma. Trauma induces coagulopathy, fibrinolysis, and hemorrhage, which together increase the demand for blood transfusion. Pelvic fractures are linked with significant blood loss that often requires blood transfusion. Hemorrhage in trauma patients is commonly managed with blood transfusion and blood substitutes. Tranexamic acid (TXA), an agent that prevents fibrinolysis, has been increasingly used to minimize bleeding with high efficacy and safety in major trauma surgeries such as pelvic fractures.

We reviewed the literature on certain studies (clinical trials, research studies, and meta-analyses) that evaluated the application of TXA in orthopedic trauma cases. Such as pelvic and hip fractures, long bone fractures, and polytrauma on PubMed, Scopus, and Google Scholar.

Most studies support that TXA effectively decreases blood loss and the necessity for blood transfusions during surgery, especially when used soon after an injury. It has been found safe, as it does not escalate the risk of thromboembolic incidents.

The use of TXA is widely accepted; however, there is still debate regarding the dose, timing, and patient selection across hospitals. These inconsistencies highlight the need for clearer guidance and standardized practice.

Transamine is an effective and safe antifibrinolytic agent for reducing blood loss in orthopedic trauma. However, further high quality studies are required to establish standardized protocols for its use across different fracture types and trauma scenarios.