Tranexamic acid for traumatic injury

Tranexamic acid for traumatic injury

• tranexamic acid is a synthetic lysine analog that inhibits the activation of plasminogen to plasmin
  • plasmin is an autologous serum protease that breaks down fibrin and therefore tranexamic acid inhibits fibrinolysis
    
• systematic reviews have shown that tranexamic acid is likely to be effective in reducing bleeding and improving outcomes in patients with traumatic injury (1,2)
  
• in acute haemorrhage, tranexamic acid is effective in reducing bleeding and mortality, although to different extents in trauma, peripartum, and surgical settings (3)
  
• Fouche et al showed, with respect to the use of tranexamic acid in acute trauma in the emergency setting, that tranexamic acid:
  • decreased 1-month and 24-hour mortality compared to placebo, with no indication of increased occlusive events
  • out-of-hospital administration of tranexamic acid was associated with decreased mortality compared to inhospital administration

Reference:

• Karl V et al. Association of tranexamic acid administration with mortality and thromboembolic events in patients with traumatic injury: a systematic review and meta-analysis.JAMA Netw Open. 2022; 5e220625
• Ker K et al. Antifibrinolytic drugs for acute traumatic injury.Cochrane Database Syst Rev. 2015; 5: CD004896
• Franchini M, Focosi D, Zaffanello M, Mannucci P M. Efficacy and safety of tranexamic acid in acute haemorrhageBMJ 2024; 384 :e075720
• Fouche PF et al. Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Annals of Emergency Medicine (November 22nd 2023).