Trauma patients treated early with tranexamic acid have better survival

UK: According to a study published in the Journal Transfusion, initial tranexamic acid treatment enhances survival in both severely and non-severely injured trauma patients, and its use should not be limited to the severely injured.

After an injury, bleeding is one of the main causes of death. When administered in a timely manner, tranexamic acid (TXA) medication lowers mortality due to bleeding and all causes without raising the risk of thrombotic adverse effects. Which trauma victims benefit from TXA treatment isn't clear, though.

In this study, the investigators looked at how TXA treatment affected trauma patients with severe and less severe injuries.

The authors evaluated the effects of TXA on survival in over 1000 trauma patients participating in randomized trials using individual patient data from meta-analysis. They used the following criteria to determine the severity of an injury: a Glasgow Coma Scale score of less than nine, any GCS with one or more fixed dilated pupils, and systolic blood pressure less than 90 mm Hg and a heart rate greater than 120 beats per minute. Survival on the day of the injury was the key performance indicator. The impact of TXA on survival in patients with and without serious injuries was investigated, as well as how these effects changed with the passage of time between injury and therapy. The secondary endpoint was survival at 28 days. Fatal and non-fatal thrombotic episodes were safety outcomes (myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis).

Conclusive points of the study:

• On the day of the injury, tranexamic acid significantly improved survival (OR = 1.22, 95% CI 1.11-1.34; p < .01).
• Tranexamic acid had a similar effect on survival in patients who weren't severely injured (OR = 1.25, 1.03-1.50) as it did in those who were (OR = 1.22, 1.09-1.37), with no discernible heterogeneity (p =.87).
• Treatment given during the first hour of an accident was most successful in both highly and less severely injured patients.
• With tranexamic acid, there was no rise in either fatal or non-fatal thrombotic events (OR = 0.88, 95% CI 0.74-1.04; p =.12).
• In patients who had not sustained significant injuries, there was variability in the therapeutic impact with treatment delay (p =.01), but not in patients who had (p =.36).

The authors came to the conclusion that TXA should not just be used for the most badly injured since it can save lives in patients who have had less severe injuries.

REFERENCE

Ageron, F-X, Shakur-Still, H, Roberts, I. Effects of tranexamic acid treatment in severely and non-severely injured trauma patients. Transfusion. 2022; 62( S1): S151– S157. https://doi.org/10.1111/trf.16954