Written by Ketan Patel
Spoon Feed
This PATCH-Trauma secondary analysis tightens the window of tranexamic acid (TXA) administration to the first ~90 minutes post-injury for maximal mortality benefit, echoing the early-benefit signal from the STAAMP trial.
The golden hour-and-a-half
Most guidelines delineate a 3-hour window for administration of TXA post-injury to reduce mortality in trauma. The true mortality benefit within this 3-hour window has never been truly stratified, and this study aims to answer whether the time to administration within this window has mortality benefit at 28-days post-trauma.
This is an exploratory secondary analysis of the PATCH-Trauma randomized, double-blind trial (n=1,287) cohort using multivariable fractional polynomial interactions and log-binomial regression. They found a mortality benefit concentrated within the first 90 minutes: TXA 67/393 (17%) vs. placebo 91/363 (25%); adjusted risk ratio 0.64 (95%CI 0.50–0.82). No benefit was found beyond 90 minutes, with an adjusted risk ratio of 1.04 (0.74–1.47). The overall adjusted risk ratio is 0.78 (0.64–0.95).
This is an exploratory study, underpowered for interaction effects, predominantly in blunt trauma patients in advanced systems, with potential residual confounding. So, generalizability to penetrating injury and settings without precise prehospital timing is uncertain.
How will this change my practice?
Working in a level 1 trauma center and also with prehospital EMS in a large urban center, TXA is already entrenched in our treatment protocols. For trauma, I will likely reach for TXA sooner and advocate for earlier TXA administration, as timing seems to be a key factor with minimal downside. However, I would like to see better data, with inclusion of penetrating trauma, to truly assess the benefits of this proposed 90-minute window.
Source
Tranexamic Acid Timing and Mortality Impact After Trauma. Ann Emerg Med. 2025 Aug 1:S0196-0644(25)00989-8. doi: 10.1016/j.annemergmed.2025.06.609. Epub ahead of print. PMID: 40751727.
