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Prehospital TXA for Trauma – Meta-analysis

March 18, 2021

Written by Cliff Freeman

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When given by prehospital providers for suspected significant hemorrhage, TXA reduces 24-hour mortality but doesn’t affect 28-30-day mortality.

Why does this matter?
We have been searching for ways to improve mortality and morbidity in trauma since there has been trauma.  CRASH 2 increased interest in tranexamic acid as the potential lifeblood. CRASH 3 suggested improvement in mortality for TBI with a GCS >9, particularly if given early. Well, it doesn’t get any earlier than in an ambulance. So, does it work?

Don’t stop believing?
This is a systematic review and meta-analysis of four studies (3 observational, 1 RCT – STAAMP) in which prehospital TXA was given for significant traumatic hemorrhage. Three studies looked at mortality in the first 24 hours. The TXA group had 1076 total patients and the no-TXA cohort had 1073. There was a 40% reduction in the odds of death with TXA (n=38) compared to without (n=62), OR 0.60 (95%CI 0.37-0.99], p=0.05). Three studies also recorded mortality between 28 and 30 days. The TXA group included 1062 patients and no-TXA had 1072. There was no statistical difference here, with 85 deaths in the TXA group and 117 in the no-TXA cohort, OR 0.69 (95%CI 0.47-1.02, p=0.06). All four studies reported the incidence of venous thromboembolism, and there was no statistical significance here either but a possible signal of increased clotting in the TXA group. This seems to leave us with more questions than answers when it comes to TXA in trauma, but it doesn’t seem to be the magic potion we all wanted it to be.

The Impact of Pre-Hospital TXA on Mortality among Bleeding Trauma Patients: A Systematic Review and Meta-Analysis. J Trauma Acute Care Surg. 2021 Feb 17. doi: 10.1097/TA.0000000000003120. Epub ahead of print.

What are your thoughts?