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General Critical Care

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Study Summary: Prehospital Tranexamic Acid for Severe Trauma

Research Question: Does administering tranexamic acid (TXA) before hospital admission improve survival with a favorable functional outcome in patients with major trauma and suspected trauma-induced coagulopathy?


Methodology: A randomized controlled trial was conducted involving adults at risk for trauma-induced coagulopathy. Participants were randomly assigned to receive either tranexamic acid or a placebo. TXA was given intravenously as a 1-gram bolus dose before hospital admission, followed by a 1-gram infusion over 8 hours after arrival. The primary outcome measure was survival with a favorable functional outcome at 6 months using the Glasgow Outcome Scale–Extended (GOS-E). Secondary outcomes included 28-day and 6-month mortality rates.


Results: A total of 1,310 patients were enrolled, with 661 assigned to the TXA group and 646 to the placebo group. The study found no significant difference in survival with a favorable functional outcome at 6 months between the two groups (53.7% in the TXA group vs. 53.5% in the placebo group). However, at 28 days, the TXA group had a lower mortality rate (17.3%) compared to the placebo group (21.8%). By 6 months, the mortality rates were 19.0% in the TXA group and 22.9% in the placebo group. The occurrence of serious adverse events did not significantly differ between the groups.


Interpretation: Administering tranexamic acid prehospital did not result in a higher proportion of patients with a favorable functional outcome at 6 months compared to the placebo. However, TXA did demonstrate a reduction in mortality at 28 days. Further investigation is required to assess the benefits and risks of TXA in advanced trauma systems, considering different prehospital and in-hospital hemorrhage control strategies. It is essential to consider long-term survival and functional outcomes when evaluating interventions in trauma care.


To access the full study, click here: Prehospital Tranexamic Acid for Severe Trauma

suray Bakkar
Dr-Yasser Alwali
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