REVIEW article
Front. Disaster Emerg. Med.
Sec. Emergency Health Services
Volume 3 - 2025 | doi: 10.3389/femer.2025.1604622
Current Research Progress of Tranexamic Acid in the Management of Patients with Traumatic Injuries in Emergency Settings
Provisionally accepted
- 1Shenzhen Third People’s Hospital, Shenzhen, China
- 2Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong Province, China
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The trauma is a leading cause of global mortality, with hemorrhage being a major contributor. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing blood loss and improving outcomes in trauma patients. Despite evidence from the CRASH-2 and CRASH-3 trials demonstrating its efficacy when administered within 3 hours post-injury, tranexamic acid remains underutilized in clinical practice.This review aims to synthesize current evidence on TXA's efficacy, mechanisms, and clinical applications in the trauma management, identify research gaps, and propose future directions to optimize its use. Methods:A comprehensive literature search was conducted using PubMed, Embase, and Cochrane Library up to April 2025. Search terms included "tranexamic acid," "trauma," "hemorrhage," and "emergency medicine." Included studies were randomized controlled trials (RCTs), systematic reviews, meta-analyses, or observational studies evaluating TXA's efficacy, safety, or mechanisms in trauma patients. Case reports, editorials, and non-English studies were excluded. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Results:The review included 31 studies (15 RCTs, 10 systematic reviews, 6 observational studies). Early the TXA administration within 3 hours post-injury significantly reduced mortality, with the CRASH-3 trial showing benefits within 8 hours for traumatic brain injury.TXA inhibits plasminogen activation, stabilizing clot formation and reducing fibrinolysis, while also exhibiting anti-inflammatory properties. Intravenous TXA was more effective than oral administration. TXA reduced blood transfusions, reoperations, and blood loss in surgical settings. Limitations included variability in study designs, small sample sizes, and lack of long-term. Discussion:the TXA is a critical intervention in the trauma management, reducing mortality and morbidity from hemorrhage. Early intravenous administration is preferred, and its anti-inflammatory properties may enhance recovery. However, underutilization in pre-hospital settings highlights the need for increased awareness and training. Future research should focus on individualized protocols, alternative administration routes, long-term safety, and combining TXA with other therapies to optimize trauma care.Conclusion:the TXA is a valuable therapeutic option in the trauma management, with significant potential to improve outcomes. Addressing current limitations and exploring new research directions will be essential to maximize its clinical benefits.
Keywords: Tranexamic Acid, Trauma management, emergency, Hemorrhage, antifibrinolytic
Received: 02 Apr 2025; Accepted: 08 May 2025.
Copyright: © 2025 Chang, Zhang, Liu, Wen and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Haifeng Chang, Shenzhen Third People’s Hospital, Shenzhen, China
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