The New England Journal of MedicinePrehospital Tranexamic Acid for Severe Trauma

The tranexamic acid was administered intravenously as a 1 g bolus dose before hospital admission, followed by a 1-g infusion over 8 hours upon hospital arrival.

This study investigates the effects of prehospital administration of tranexamic acid on the survival and functional outcomes of major trauma patients suspected of trauma-induced coagulopathy, who are receiving treatment within advanced trauma systems.

Key Points:

• The trial involved 1,310 adults with major trauma at risk for trauma-induced coagulopathy.
• Patients were randomly assigned to receive either tranexamic acid or placebo.
• Primary outcome was survival with a favorable functional outcome at 6 months post-injury, evaluated using the Glasgow Outcome Scale-Extended (GOS-E).
• Survival with a favorable functional outcome at 6 months was similar in both groups: 53.7% in the tranexamic acid group, 53.5% in the placebo group.
• The number of serious adverse events did not differ significantly between the two groups.

Additional Points:

• Secondary outcomes included death from any cause within 28 days and within 6 months after injury.
• At 28 days post-injury, the mortality rate was lower in the tranexamic acid group (17.3%) compared to the placebo group (21.8%).
• By 6 months, 19.0% of patients in the tranexamic acid group had died, compared to 22.9% in the placebo group.

Conclusion:

• The prehospital administration of tranexamic acid did not result in a higher number of patients surviving with a favorable functional outcome at 6 months compared to placebo.

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Did You Know?
According to a global study published in The Lancet in 2010, administration of tranexamic acid within 3 hours of injury was shown to significantly reduce the risk of death in bleeding trauma patients, highlighting its potential utility in emergency medical scenarios.