- For patients with trauma-related hemorrhage and hyperfibrinolysis upon admission, tranexamic acid (TXA) was not associated with better survival after the first 6 hours.
- Editorial calls for prospective randomized trials.
Why this matters
- With vs without TXA:
- 6-hour mortality: 16% vs 34% (P=.04);
- 24-hour plasma transfusion requirement: 15 vs 10 units (P=.03).
- No between-group difference in 12- or 24-hour or 30-day mortality, red blood cell or platelet transfusions, time to hemostasis, rebleeding, deep venous thrombosis, pulmonary embolism, cause of death.
- TXA group had more acute kidney injury, systemic inflammatory response syndrome, sepsis, multisystem organ failure.
- Secondary analysis of Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial (n=680).
- Researchers examined 118 patients with admission hyperfibrinolysis on thromboelastography.
- Using propensity matching, they compared those who did (n=31) and did not (n=62) receive TXA (at provider discretion).
- Outcome: mortality, transfusion, time to hemostasis, rebleeding after hemostasis.
- Funding: None disclosed; PROPPR supported by US, Canadian federal and defense funds.
- Small, retrospective, nonrandomized; risk for bias, confounding.