Effectiveness of tranexamic acid for acute traumatic hemorrhage and epistaxis in settings without immediate surgical support: a literature review
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Date
2024-05-15
Authors
Rots, Carey
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Abstract
Background: Tranexamic acid has been widely used for the management of acute hemorrhage. Although results remain conflicting on its benefits, several more studies have been produced since the first 2010 publication of the CRASH-2 trial. The purpose of this literature review is to examine available evidence on the efficacy of tranexamic acid for acute hemorrhage due to trauma, isolated traumatic brain injury, and epistaxis. Of particular interest is the utility of tranexamic acid in settings without immediate surgical support, such as in certain rural and remote locations of Canada.
Methods: A literature review was conducted using the PubMed database as a source for trials comparing the efficacy of tranexamic acid as a means to improve morbidity and mortality from acute hemorrhage due to trauma, traumatic brain injury, and epistaxis.
Results: A total of 195 studies were identified from the PubMed database search. After removing duplicates and applying inclusion/exclusion criteria, 18 unique studies were included in the review. There were 5 on trauma, 7 on traumatic brain injury, and 6 on epistaxis. All 18 articles were reviewed in detail, but to keep within the scope of this capstone project, a focus on 2 key studies for each topic (trauma, traumatic brain injury, epistaxis) was performed. Although intravenous tranexamic acid administered within 3 hours of injury appeared to reduce 28-day mortality due to trauma, 28-day mortality due to traumatic brain injury and longer-term neurological outcomes at 6 months were not improved for either. Efficacy of topical tranexamic acid for epistaxis management remains conflicting.
Conclusions: Tranexamic acid can be a medication used to reduce mortality in the context of acute hemorrhage due to trauma when given intravenously within 3 hours of injury. This can be especially relevant in the prehospital setting, and in rural or remote settings of Canada where there is no immediate surgical support. As there is no mortality or morbidity benefit seen when used for isolated traumatic brain injury, tranexamic acid currently has little role in its management. There is still conflicting evidence as to what further benefit tranexamic acid provides within our current armamentarium when given topically for epistaxis management. As a result, its use for this cannot be recommended for or against at this time.