Association between tranexamic acid administration and mortality based on the trauma phenotype: a retrospective analysis of a nationwide trauma registry in Japan

Abstract Background In trauma systems, criteria for individualised and optimised administration of tranexamic acid (TXA), an antifibrinolytic, are yet to be established. This study used nationwide cohort data from Japan to evaluate the association between TXA and in-hospital mortality among all patients with blunt trauma based on clinical phenotypes (trauma phenotypes). Methods A retrospective analysis was conducted using data from the Japan Trauma Data Bank (JTDB) spanning 2019 to 2021. Results Of 80,463 patients with trauma registered in the JTDB, 53,703 met the inclusion criteria, and 8046 (15.0%) received TXA treatment. The patients were categorised into eight trauma phenotypes. After adjusting with inverse probability treatment weighting, in-hospital mortality of the following trauma phenotypes significantly reduced with TXA administration: trauma phenotype 1 (odds ratio OR 0.68 95% confidence interval [CI 0.57–0.81]), trauma phenotype 2 (OR 0.73 0.66–0.81), trauma phenotype 6 (OR 0.52 0.39–0.70), and trauma phenotype 8 (OR 0.67 0.60–0.75). Conversely, trauma phenotypes 3 (OR 2.62 1.98–3.47) and 4 (OR 1.39 1.11–1.74) exhibited a significant increase in in-hospital mortality. Conclusions This is the first study to evaluate the association between TXA administration and survival outcomes based on clinical phenotypes. We found an association between trauma phenotypes and in-hospital mortality, indicating that treatment with TXA could potentially influence this relationship. Further studies are needed to assess the usefulness of these phenotypes. Graphical abstract