Globally, trauma is the leading cause of death for young people. In 2011, the World Health Organization added tranexamic acid to the Model List of Essential Medicines for the treatment of trauma based on randomized trial data showing that tranexamic acid reduces mortality of hemorrhaging trauma patients. Some data have suggested that tranexamic acid should be administered within 3 hours after injury to be most effective. To explore the effect of tranexamic acid on the quality of survival, the Pre-hospital Antifibrinolytics for Traumatic Coagulopathy and Hemorrhage (PATCH-Trauma) trial randomized a total of 1310 severe trauma patients at risk for trauma-induced coagulopathy to receive either tranexamic acid (1 g before hospital admission followed by 1 g after arrival at the hospital) or placebo at 15 emergency medical centers in Australia, New Zealand, and Germany. Overall, 19.0% (123/648) of patients in the tranexamic acid arm died six months after injury compared to 22.0% (144/629) in the placebo arm. Survival without severe disability, however, was similar in both groups (53.7% vs. 53.5%, respectively) as were adverse events. Further data is needed on tranexamic acid use in other subgroups of patients including less severe trauma patients with more potential for good recovery.
References:
- The PATCH-Trauma Investigators and the ANZICS Clinical Trials Group. Prehospital tranexamic acid for severe trauma. The New England Journal of Medicine 2023
- Shakur-Still and I. Roberts. Tranexamic acid for trauma patients—more lives to save and outcomes to consider. The New England Journal of Medicine 2023
