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The following is a summary of the study titled “Effectiveness and Safety of Prehospital Tranexamic Acid in Patients with Trauma: An Updated Systematic Review and Meta-Analysis with Trial Sequential Analysis,” published in the October 2024 issue of Emergency Medicine by Chen et al.

Tranexamic acid (TXA), a medication used to prevent blood loss, has gained attention for its potential benefits in prehospital care for patients undergoing trauma. For a study, researchers aimed to conduct a systematic review and meta-analysis to provide updated evidence on the effectiveness and safety of TXA administered before hospital arrival in trauma cases.

A team of researchers systematically reviewed related literature across PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases from their inception through July 1, 2023. Key outcomes assessed included mortality rates within 24 hours and at 28–30 days, as well as adverse events such as organ dysfunction, respiratory distress, thromboembolic events, and infection rates. Quality was evaluated using the Revised Cochrane Risk of Bias Tool for Randomized Trials (RCTs) and the Methodological Index for Nonrandomized Studies (MINORS), while trial sequential analysis estimated the required information size for conclusions. Evidence was rated through the GRADE approach.

It included 11 studies with 11,259 patients, two of which were RCTs. RCTs showed a low risk of bias, whereas non-RCT studies had moderate to critical risks of bias in various areas. Findings revealed that TXA significantly lowered 24-hour mortality rates (odds ratio [OR], 0.82; 95% CI, 0.71–0.94). In the RCT-only subgroup, prehospital TXA was also associated with reduced 28–30-day mortality (OR, 0.80; 95% CI, 0.66–0.97) but was linked to higher risks of thromboembolism (OR, 1.22; 95% CI, 1.03–1.44) and infection (OR, 1.13; 95% CI, 1.00–1.28). Additionally, TXA administration led to a decrease in transfused blood products by an average of 2.3 units (WMD, -2.30; 95% CI, -3.59 to -1.01).

The updated evidence suggests that prehospital administration of TXA reduces mortality and the need for blood transfusions in patients undergoing trauma but presents an increased risk of thromboembolic and infection-related complications. Future large-scale, well-designed RCTs are needed to confirm these findings and assess TXA’s safety and efficacy across more homogeneous patient samples.

Source: bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01119-2