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

Abstract

In trauma patients, bleeding can lead to coagulopathy, hemorrhagic shock, and multiorgan failure, and therefore is of fundamental significance in regard to early morbidity. We conducted a meta-analysis to evaluate the efficacy and safety of tranexamic acid (TXA) in civil and military settings and its impact on in-hospital mortality (survival to hospital discharge or 30-day survival), intensive care unit and hospital length of stay, incidence of adverse events (myocardial infarct and neurological complications), and volume of blood product transfusion. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature using PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Central Register and Controlled Trials (CENTRAL) database was conducted from inception to 10 January 2021. In-hospital mortality was reported in 14 studies and was 15.5% for the TXA group as compared with 16.4% for the non-TXA group (OR = 0.81, 95% CI 0.62–1.06, I2 = 83%, p = 0.12). In a civilian TXA application, in-hospital mortality in the TXA and non-TXA groups amounted to 15.0% and 17.1%, respectively (OR = 0.69, 95% CI 0.51–0.93, p = 0.02, I2 = 78%). A subgroup analysis of the randomized control trial (RCT) studies showed a statistically significant reduction in in-hospital mortality in the TXA group (14.3%) as compared with the non-TXA group (15.7%, OR = 0.89, 95% CI 0.83–0.96, p = 0.003, I2 = 0%). To summarize, TXA used in civilian application reduces in-hospital mortality. Application of TXA is beneficial for severely injured patients who undergoing shock and require massive blood transfusions. Patients who undergo treatment with TXA should be monitored for clinical signs of thromboembolism, since TXA is a standalone risk factor of a thromboembolic event and the D-dimers in traumatic patients are almost always elevated.

Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

“…Several meta-analyses have been done to explore the risk and benefits of TXA in trauma [ 20 – 23 ]. These meta-analyses, however, contain few studies on prehospital administration of TXA [ 1 , 20 ], whereas most were conducted in the hospital settings [ 21 , 23 – 26 ]. Evidence indicates that TXA reduces death secondary to bleeding by as much as 32% if given within 1 h of injury, but may increase death if given after 3 h [ 27 ].…”

“…Although TXA has a half-life of 2.3 h in adult patients [ 29 ], one study showed that in one-fifth of cases, a single dose of TXA given en route to the hospital did not attain adequate plasma level measured at hospital admission [ 27 ]. Moreover, TXA administration may increase the risk of thromboembolic complications, particularly when higher or repeated doses are used as shown in the MATTERS and HALT-IT trials [ 21 , 30 , 31 ]. Moreover, there are few studies on the efficacy and safety of TXA en route to the hospital or at the scene [ 20 , 32 – 35 ].…”

Place of tranexamic acid in traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

“…This systematic review and meta-analysis were performed under the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines [14]. This study represents a continuation of prior research on the use of TXA previously undertaken by the authors [15,16].…”

Place of tranexamic acid in modern medicine

“…Tranexamic acid (TXA) is a low molecular antifibrinolytic drug [1] that has been used for many years to control hemorrhage in patients with hemophilia and other disorders involving coagulation system. The particular interest in TXA use was initially found by its ability to control massive hemorrhages in the prehospital setting, especially in the tactical environment, due to a statistically significant reduction of risk of death, when used in the early stage of pharmacotherapy [2][3][4]. The search for the safe and effective drug, which may be used in the prehospital control of hemorrhage is related to the epidemiology of injuries and its impact on the mortality of the overall population.…”