Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin, stabilizing previously formed clots (J Thromb Haemost 2015;13:S195-9; Eur J Haematol 2020;104:79-87; Crit Care Clin 2017;33:85-99). TXA has been well studied in non-trauma patients and has been shown to decrease bleeding and improve outcomes (J Thromb Haemost 2015;13:S195-9; Health Technol Assess 2013;17:1-79). Worldwide, trauma continues to be a leading cause of mortality, often due to uncontrolled bleeding. Recent studies have shown that TXA may also be beneficial in trauma patients. However, concerns remain about its administration, dosing, and potential side effects such as thromboembolic events.
CRASH-2 is the largest study conducted on TXA administration in trauma patients. It was a randomized controlled trial conducted across 274 hospitals in 40 countries that enrolled 20,211 adult trauma patients deemed to be at risk for significant bleeding. The investigators found...