Use of tranexamic acid in trauma surgical specialties: a narrative review

BACKGROUND: Tranexamic acid (TXA) is a well-known antifibrinolytic agent with increasing evidence supporting its use in trauma patients. This review evaluates the current available literature regarding TXA and its potential use to improve patient survival and reduce transfusion needs across multiple trauma surgical subspecialties and contexts. METHODS: A literature review was conducted on the efficacy and safety of tranexamic acid in trauma surgical specialties using PubMed (MEDLINE) and Google Scholar from database inception to October 2024. Selected articles were written in the English language and encompassed reviews, experimental studies, and basic science articles. RESULTS: There is conflicting evidence on the mortality benefit of TXA, particularly in the prehospital setting. However, multiple large, high-quality studies have shown that TXA is an effective agent to reduce bleeding after trauma. Extensive evidence exists that TXA is a safe medication, with numerous studies demonstrating no increased risk of thromboembolic events after administration of TXA in trauma settings. Additionally, multiple cost-effectiveness studies conducted in several countries have found TXA to be a highly cost-effective intervention following trauma. CONCLUSION: TXA is a safe, effective, and cost-effective medication to reduce bleeding after trauma. Future research on TXA is needed to elucidate the potential benefit of TXA after traumatic brain and spine injury and the optimal dose and route of administration of TXA.