The Safety and Efficacy of Transexamic Acid in Polytrauma Patients

Authors

• John J. Reidelbach II, U of LynchburgFollow

Specialty

Trauma Medicine

Abstract

Severe hemorrhage is a leading cause of preventable death in polytrauma. Although tranexamic acid (TXA) is a global adjunct in resuscitation, clinical parameters for its optimal use remain non-standardized.  The intent of this review is to evaluate, digest, and synthesize the multitude of data concerning identified specifics of TXA use in polytrauma.  A comprehensive database search was conducted in PubMed and the Cochrane Library to identify and assess trials and reviews on specific usage parameters, including indications, dosages, timing, efficacy, and outcomes in trauma resuscitation.  Severe hemorrhage remains a leading cause of preventable death in trauma patients worldwide.  TXA, an antifibrinolytic agent that prevents clot degradation, has been adopted worldwide as an additional adjunct to control severe hemorrhage in resuscitation algorithms.

Five landmark trials were reviewed, including civilian and military data, hospital and prehospital data, specifically regarding TXA use in trauma patients.  Inspection concurs TXA administration should be triggered by physiologic signs of hemorrhagic shock rather than mechanism of injury alone, as data suggests benefit in the reduction of mortality from exsanguination-related death.  The efficacy of TXA diminishes over time; optimal benefit occurs with administration within 60–90 minutes post-insult, whereas administration beyond 3 hours may increase mortality risk.  This is likely due to the shift from post-traumatic hyperfibrinolysis driven by a surge in tissue plasminogen activator (tPA), to a fibrinolysis “shutdown” as circulating tPA is exhausted, leading to a potentially hypercoagulable state. The most studied dose at this time remains a 1 gram intravenous (IV) bolus, followed by a 1 gram IV infusion over 8 hours.  In traumatic brain injury (TBI), the benefits of TXA appear restricted to mild-to-moderate cases.  However, several trial-wide limitations complicate these findings, including disparate resource allocation among centers, a lack of pediatric and dose-comparison data, and insufficient tracking of long-term functional outcomes.  Continued research addressing these information gaps will be critical for identifying universal parameters on optimal TXA use in trauma resuscitation.

Recommended Citation

Reidelbach JJ. The Safety and Efficacy of Transexamic Acid in Polytrauma Patients. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).