Introduction: Tranexamic acid (TXA) is an antifibrinolytic drug that has shown efficacy in reducing mortality due to bleeding in trauma patients if administered within three hours of injury. Its use in prehospital settings has been increasingly recognized for its potential to improve outcomes. However, evidence regarding the efficacy of prehospital administration of TXA on trauma outcomes is limited. This study evaluates the use and outcomes of TXA administration in Region 2 South, which encompasses 2.5 million residents. Methods: An observational retrospective study collected data from trauma patients who received TXA from January 2022 to June 2024. There were 32,284 trauma EMS runs during this period. 24 patients met the inclusion criteria for TXA administration. Data on appropriate use, subsequent doses, complications, and outcomes were analyzed. Results: Among 24 patients, 6 (25%) had penetrating trauma, 16 (66.7%) had blunt trauma, and 2 had unknown etiologies. TXA administration occurred 7 times in 2022, 13 times in 2023, and 4 times in 2024. All TXA administrations followed protocol. Indications for TXA administration were evidence of blood loss (n=21, 87.5%), hypotension (n=14, 58.3%), and mortality (n=3, 12.5%). Most scene times were less than 15 minutes (n=19, 79.2%). Four patients (16.7%) died, half within 24 hours, with no deaths attributed to thrombotic events or ongoing hemorrhage. No second dose of TXA was given. Conclusion: Despite the benefits of TXA, its administration remains uncommon. Our findings suggest TXA can be correctly administered per protocol by EMS without serious complications or delay in scene time. Due to the small sample size, we are unable to establish a correlation between TXA administration and mortality benefits. Further studies are warranted to corroborate these findings and provide comparative data to reinforce the evidence supporting the use of TXA in the prehospital setting. Further investigation is needed to determine why a subsequent dose of TXA was not administered.
Klausner et al. (Sun,) studied this question.