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The role of tranexamic acid in trauma — a life-saving drug with proven benefit

Nature Reviews Disease Primers volume 8, Article number: 34 (2022) Cite this article

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Uncontrolled bleeding is a leading cause of death after traumatic injury. Evidence from large-scale randomized trials shows that urgent treatment with tranexamic acid (TXA) reduces bleeding deaths and all-cause mortality, without increasing the risk of thrombotic adverse events1,2. TXA also reduces head injury deaths in patients with traumatic brain injury3. In their article (Moore, E. E. et al. Trauma-induced coagulopathy. Nat. Rev. Dis. Primers 7, 30 (2021)), Moore and colleagues4 argue that TXA should only be used if patients have viscoelastic haemostatic assay (VHA) evidence of hyperfibrinolysis. In the pre-hospital setting, where VHA results are unavailable, the authors suggest that TXA use should be limited to severely injured patients, based on the belief that shock is the main driver of fibrinolytic dysregulation.

Their claims are unsupported by evidence from randomized trials. These analyses show that the effect of TXA on death due to bleeding is similar regardless of mechanism of injury, systolic blood pressure and baseline risk of death due to bleeding5,6. Recent pathophysiological studies show that early empirical TXA prevents admission fibrinolysis and reduces mortality but does not increase late mortality regardless of the fibrinolysis pattern in the 24 h after injury7.

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Fig. 1: The effect of TXA on all-cause mortality at 24 hours and 28 days.

References

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Authors and Affiliations

  1. Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK

    Ian Roberts

  2. Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

    Francois-Xavier Ageron

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  1. Ian Roberts
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  2. Francois-Xavier Ageron
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Correspondence to Ian Roberts.

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Nature Reviews Disease Primers thanks D. Fries and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Roberts, I., Ageron, FX. The role of tranexamic acid in trauma — a life-saving drug with proven benefit. Nat Rev Dis Primers 8, 34 (2022). https://doi.org/10.1038/s41572-022-00367-5

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