Prehospital tranexamic acid in trauma and traumatic brain injury: a systematic review with meta-analysis of randomized comparative evidence

 Your competent? doctor put together a protocol on this years ago, right? NO? 

• tranexamic acid (17 posts to March 2013)

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

Prehospital tranexamic acid in trauma and traumatic brain injury: a systematic review with meta-analysis of randomized comparative evidence

• Khalid Nabeel Almulhim &
• Mohammed Almulhim 

• 12 Accesses

• Explore all metrics 

We’re sharing this article early to provide faster access to peer-reviewed, accepted research. It is citable and carries a permanent DOI. This version is subject to further edits and will be replaced automatically by the final Version of Record. All legal disclaimers apply.

Abstract

Background

Tranexamic acid (TXA) is commonly used in trauma care to decrease bleeding, but its effectiveness and safety in prehospital settings, notably in traumatic brain injury (TBI), remain controversial. This review aimed to systematically evaluate the evidence on prehospital tranexamic acid (TXA) use in trauma and traumatic brain injury (TBI), with quantitative meta-analysis restricted to randomized comparative evidence and non-randomized evidence summarized narratively.

Methods

We conducted a systematic review with quantitative meta-analysis restricted to independent randomized comparative studies evaluating prehospital TXA versus placebo, usual care, or no TXA. Observational studies, secondary analyses, and survey studies were summarized separately and were not pooled with randomized trials in the primary efficacy or safety meta-analysis. outcomes included mortality (28/30-day, in-hospital), thromboembolic events, seizures, and neurological consequences. Risk of bias was evaluated using Cochrane risk of bias tools for randomized controlled trials (RoB2) and non-randomized studies by Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I).

Results

Twenty-one reports met the broad review criteria. The RCT-only analysis of 28- or 30-day mortality included three independent parent randomized trials: PATCH-Trauma/Gruen et al. 2023, STAAMP/Guyette et al. 2021, and ROC-TXA/Rowell et al. 2020. Prehospital TXA was associated with lower 28- or 30-day mortality (RR 0.81, 95% CI 0.68–0.95). The TBI mortality result was derived solely from ROC-TXA/Rowell et al. 2020 and was therefore a single-study estimate rather than a pooled estimate (RR 0.87, 95% CI 0.64–1.20). In-hospital mortality was reported only by STAAMP/Guyette et al. 2021 and was also a single-study estimate (RR 0.87, 95% CI 0.57–1.33). No statistically significant increase in thromboembolic events or seizures was demonstrated. However, the DVT and PE point estimates were above the null, and their wide confidence intervals did not exclude a clinically relevant increase in thromboembolic risk.

Conclusion

Prehospital TXA may reduce 28- or 30-day mortality in selected broader trauma populations, particularly among patients at risk of hemorrhage. No statistically significant increase in thromboembolic events or seizures was demonstrated; however, clinically relevant thromboembolic harm cannot be excluded because the DVT and PE point estimates were above the null, and the confidence intervals were wide.