Effects of Tranexamic Acid on Mortality and Blood Transfusion in Trauma Patients with Significant Hemorrhage: A Clinical Trial

Abstract

Extensive hemorrhage is a significant cause of mortality in trauma patients. Tranexamic acid has been used for controlling bleeding in cardiovascular surgeries and dental manipulations in patients with hemophilia. However, in traumatic patients with bleeding, its use dates back to more recent years. This study aims to examine the effects of this drug on reducing mortality and blood transfusion rate in trauma patients with significant hemorrhage. A total of 60 patients with significant trauma-related hemorrhage (systolic blood pressure < 90 mmHg/heart rate > 110/min) from the emergency department of Imam Reza Hospital (Tabriz, Iran), were randomized in two groups. The case group received intravenous Tranexamic acid (1 g in 10 min and then 1 g over 8 h). The control group received placebo. Rate of transfusion and rate of one-month mortality were compared between the study groups. The mean ICU stay and overall hospitalization times did not have significant difference between two groups (p<0.05). Transfusion of packed cells was 6.03±1.50 and 6.03±1.22 units in case and control groups respectively. Transfusion of fresh frozen plasma (FFP) was 2.50±1.36 and 3.03±0.96 units in case and control groups respectively (p=0.09). Transfusion of platelets was 0.40±0.20 1.33±0.31 units in case and control groups respectively (p=0.01). Three patients (10%) in the case group and 4 patients (13.3%) in the control group were expired (p=0.50). Tranexamic acid is safe and effective in reducing platelet transfusion rate in patients with trauma-related significant hemorrhage. However, transfusion need and mortality would not reduce by its use in trauma patients.

Efficacy and Safety of Tranexamic Acid in Emergency Trauma: A Systematic Review and Meta-Analysis

“…From those studies, we only included thirty-seven trials for full-text evaluation. Finally, 17 studies were found to be eligible for quantitative analysis [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. The details of the selected trials are summarized in Table 1 and Table S1 .…”

“…The details of the selected trials are summarized in Table 1 and Table S1 . Among the seventeen studies, four studies were carried out in combat conditions [ 23 , 27 , 29 , 30 ], and 13 studies were carried out on civilian injuries [ 24 , 25 , 26 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Three studies were designed as randomized controlled trials [ 26 , 28 , 36 ].…”

“…The sample sizes of the included studies ranged from 40 to 20,207, with a total of 30,571 individuals, which altogether included patients with trauma treated with TXA ( n = 14,413) or non-TXA ( n = 16,158). Among the 17 articles, eight were conducted in USA [ 23 , 26 , 27 , 31 , 32 , 33 , 35 , 37 , 38 ], and one in each of the following countries: UK [ 24 ], Qatar [ 25 ], Iran [ 28 ], Israel [ 29 ], Afghanistan [ 30 ], Canada [ 34 ], and Germany [ 39 ]. One study was also conducted as a multi-country trial [ 36 ].…”