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General Critical Care

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Prehospital Tranexamic Acid for Severe Trauma

What were the findings of the PATCH-Trauma trial regarding the use of tranexamic acid in patients with major trauma and suspected trauma-induced coagulopathy?

  • 0%Improved survival and functional outcomes.

  • 0%Reduced mortality but did not improve functional outcomes.

  • 0%No effect on mortality or functional outcomes.

  • 0%I do not know!

The PATCH-Trauma trial aimed to determine whether the prehospital administration of tranexamic acid, 1 g IV one dose then 1 g infusion for 8 hours, would improve the survival and functional outcomes of patients with major trauma and suspected trauma-induced coagulopathy. The study involved 1,310 patients who were randomly assigned to receive either tranexamic acid or a placebo.

The results showed that there was no significant difference in the percentage of patients with a favorable functional outcome at 76 months after the injury between the tranexamic acid group and the placebo group.

Both groups had similar rates of survival with a favorable functional outcome at 6 months. However, the tranexamic acid group had a lower rate of death within 28 days compared to the placebo group.

The trial confirmed the previous findings that tranexamic acid can reduce mortality in patients with bleeding trauma. It was most effective when administered early, within 3 hours of injury. The drug did not increase the risk of vascular occlusive events. However, the study did not find evidence that tranexamic acid improved functional outcomes in the long term.

The researchers highlighted the importance of considering not only survival but also functional recovery in trauma care. While tranexamic acid may save lives in the short term, patients may still experience severe disability in the long term. Disability is a complex and evolving outcome influenced by various factors, and effective rehabilitation is crucial for improving outcomes.

Overall, while tranexamic acid has demonstrated its effectiveness in reducing mortality, its impact on long-term functional outcomes remains uncertain. Future studies should focus on optimizing rehabilitation strategies for trauma patients and expanding the use of tranexamic acid to different patient populations.

The PATCH-Trauma Investigators and the ANZICS Clinical Trials Group. Prehospital tranexamic acid for severe trauma. N Engl J Med 2023;389:127-136. Link

Rania Albakri
Mazen Kherallah
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