Keywords
Prehospital care
Trauma
Hemorrhagic shock
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: Analyze the scientific evidence on the safety and efficacy of administering tranexamic acid (TXA) in the pre-hospital environment and the impact of its use on the mortality of victims. Methods: This is an integrative literature review using the PubMed Central (PMC) database, carried out between August and December 2023. Articles published between 2013 and 2022 in Spanish, French, English and Portuguese were considered. Results: A total of 5,561 articles were found and 18 were selected to make up the final sample. Despite being restricted to selected patients, most of the articles show a reduction in mortality and length of hospital stay for victims of severe trauma with a risk of bleeding and moderate traumatic brain injury, a lower rate of blood product transfusions during hospitalization, the same benefit not observed in victims of severe head trauma with a Glasgow Coma Scale score of less than 8. Final considerations: The use of TXA has been shown to be effective in reducing mortality in severe polytraumatized patients at risk of bleeding. Its use is still restricted to individuals over the age of 12, with its use indicated within 3 hours of the trauma, ideally within the first hour of the injury, according to some studies.
References
BOSSERS SM, et al. Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury. JAMA Neurology 2020; 78(3): 338–345.
DEEB A-P, et al. Prehospital synergy: Tranexamic acid and blood transfusion in patients at risk for hemorrhage. J Trauma Acute Care Surg 2022; 93(1): 52–58.
DIXON AL, et al. TXA Administration in the Field Does Not Affect Admission TEG after Traumatic Brain Injury. J Trauma Acute Care Surg 2020; 89(5): 900–907.
GRUEN RL, et al. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med 2023; 389(2): 127–136.
GUYETTE FX, et al. Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surgery 2020; 156(1): 11–20.
IMACH S, et al. The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®. Crit Care 2021; 25(1): 277.
KUNZE-SZIKSZAY N, et al. The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine. Scandinavian Journal of Trauma, Ressuscitation and Emergency Medicine 2016; 24(1): 122.
MITRA B, et al. Protocol for a multicentre prehospital randomised controlled trial investigating tranexamic acid in severe trauma: the PATCH-Trauma trial. BMJ Open 2021; 11(3): e046522.
NEGAHI A, et al. The effect of early tranexamic acid on bleeding, blood product consumption, mortality and length of hospital stay in trauma cases with hemorrhagic shock: a randomized clinical trial. J Prev Med Hyg 2021; 62 (4): E958–E965.
NEEKI MM, et al. Tranexamic Acid in Civilian Trauma Care in the California Prehospital Antifibrinolytic Therapy Study. Western Journal of Emergency Medicine 2018; 19(6): 977–986.
NUTBEAM T, et al. Use of tranexamic acid in major trauma: a sex-disaggregated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials and UK trauma registry (Trauma and Audit Research Network) data. British Journal of Anaesthesia 2022; 129: 191–199.
QUINTANA-DÍAZ M, et al. Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad 2022; 50(4): 1–8.
ROBERTS I, et al. Tranexamic acid in bleeding trauma patients: an exploration of benefits and harms. Trials 2017; 18(1): 48.
ROBERTS I, et al. Tranexamic acid to reduce head injury death in people with traumatic brain injury: the CRASH-3 international RCT. Health Technology Assessment 2021; 25(26):1–76.
ROWELL SE, et al. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. JAMA 2020; 324(10): 961–974.
STEIN P, et al. The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients. Anesthesia and Analgesia 2018; 126(2): 522–529.
THE CRASH-3 TRIAL COLLABORATORS. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019; 394(10210): 1713–1723.
THE UK CRASH-4 TRIAL COLLABORATION. Intramuscular tranexamic acid for symptomatic mild traumatic brain injury in older adults: a pilot randomised, placebo-controlled trial (The CRASH-4 trial pilot phase). 2022.
WILLIAMS J, et al. A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury. Trials 2022; 23(1): 370.
YUSSOF SJM, et al. Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia. Med J Malaysia 2019; 74(4): 300–306.