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Traumatic bleeding: tranexamic acid reduces mortality

In victims of severe traumatic bleeding, the administration of tranexamic acid, preferably in the hour following the trauma, and in any case within 3 hours, has a favourable harm-benefit balance.

Severe traumas, especially those resulting from traffic accidents, are a major cause of mortality worldwide, often as a consequence of a head injury or a haemorrhagic shock.

Treatment of patients with severe haemorrhagic trauma involves surgery or other interventions to stop the bleeding, and blood transfusions. Tranexamic acid inhibits the breakdown of the fibrin making up blood clots, and thus helps reduce bleeding and the need for post-operative blood transfusions.

According to a large-scale clinical trial, the administration of tranexamic acid via a slow intravenous infusion makes it possible to avert one death for around 70 patients  treated, especially if it is given within the first hour. This benefit seems to lessen with time, and can even be harmful after 3 hours. In cases of severe head injury, tranexamic acid has no proven effect on mortality.

The adverse effects of tranexamic acid are chiefly thromboses, digestive disorders, hypotension in the case of rapid intravenous injection, and an increased risk of convulsions in the case of high intravenous doses.

In practice, in victims of severe hemorrhagic trauma, tranexamic acid is easy to use even outside the hospital environment, and it is likely to extend the life of some accident patients.
When bleeding is not life-threatening, it seems wise to avoid exposing patients to tranexamic acid, especially those with a higher risk of thrombosis.

©Prescrire 1 July 2013

"Trauma and severe bleeding. Tranexamic acid within one hour to reduce mortality" Prescrire Int 2013; 22 (140): 189-190. (Pdf, subscribers only).
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See also:

Tranexamic acid
and thrombosis
Prescrire Int 2013;
22 (140): 182-183.
Pdf, subscribers only