Tranexamic acid in prehospital emergency medicine: Evidence and availability in Vojvodina

Introduction: Massive hemorrhage is one of the leading causes of preventable mortality in prehospital settings. Tranexamic acid (TXA), a potent antifibrinolytic agent, has demonstrated significant potential in reducing mortality among polytraumatized patients, particularly when administered promptly within the "golden hour." The aim of this study was to critically analyze contemporary literature on the effectiveness of TXA in prehospital emergency medicine and to assess its current availability in emergency medical services (EMS) in the Autonomous Province of Vojvodina. Methods: The study consisted of a theoretical review of key clinical trials (CRASH-2, CRASH-3, PATCH, STAAMP) and a descriptive survey. The survey was conducted among head nurses/medical technicians in 22 EMS in Vojvodina to evaluate the availability of TXA in ambulance units. Results: The literature review confirms that early prehospital administration of TXA significantly improves clinical outcomes. The survey was conducted in 22 EMS in Vojvodina, with 18 responses received (response rate 81.8%). TXA was available in only 2 (11.1%) services, whereas 16 (88.9%) services reported that TXA had not been procured and was not available for prehospital use. Conclusion: There is a significant discrepancy between contemporary clinical evidence and the actual availability of TXA in prehospital practice in Vojvodina. Urgent revision of local protocols and inclusion of TXA in the standard equipment of all emergency medical services are necessary in order to reduce preventable mortality among critically bleeding patients.