TXA in Trauma
/Fouche PF, Stein C, Nichols M, et al. Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2024;83(5):435–45.
This metanalysis published in May 2024 investigated the use of TXA in severely injured trauma patients. They ultimately included a total of 7 randomized control trials that evaluated TXA use for patients with traumatic injures: 3 of these studies looked at general polytrauma and the other 4 focused specifically on isolated intracranial hemorrhage. Patients were only included in the individual RCTs if there was significant concern for bleeding; they had to have hemodynamic instability such as hypotension or tachycardia, an identified bleeding source, or a known ICH with a depressed GCS. TXA dosing was standardized in all trials to a 1g bolus over 10 minutes followed by a 1g infusion over 8 hours. The primary outcome was 30-day mortality, with secondary outcomes of 24-hour mortality and vascular occlusive events such as DVT, PE, MI, or stroke.
The investigators found that patients that received TXA overall had a mortality benefit compared to placebo, with an odds ratio of 0.89 and a NNT of 61. The absolute mortality reduction was 1.7% in the TXA group. Subgroup analyses showed that there was also a mortality benefit at 24-hours. There was no significant difference in vascular occlusive events in patients that received TXA compared to placebo. TXA appeared to have the strongest benefit when given early (i.e. In the prehospital setting) and in patients with generalized polytrauma.
Authorship
Written by Sarah Moulds, MD, PGY-4, University of Cincinnati Department of Emergency Medicine
Editing and Posting by Jeffery Hill, MD MEd, Associate Professor, University of Cincinnati Department of Emergency Medicine
Cite As: Moulds, S. Hill, J. TXA in Trauma. www.tamingthesru.com. www.tamingthesru.com/blog/journal-club/txa-trauma. 7/2/2024
