TXA in Trauma: clarity still lacking but might be coming.

This letter published in the April EMA nicely sums up the current evidence gaps regarding Tranexamic acid in multitrauma patients. The letter is from the PATCH study investigators .

In summary, the current state of play is that CRASH2 gave us pretty good evidence of benefit of early TXA in multitrauma patients in the developing world. MATTERS provided some encouraging registry data supporting use of TXA in battlefield trauma. What we don’t know is whether mutitrauma patients with early access to rapid transport to definitive care, plentiful blood and blood product transfusion, interventional radiology, advanced surgical procedures and high quality intensive care will also benefit or whether we can expect thrombotic complications (CRASH 2 didn’t find thrombotic complications but MATTERS did which may represent the difference between a randomised trial and a registry study or may represent differences in access to diagnostic tests for thrombotic complications).

PATCH will be the first randomised study of TXA in trauma patients in a developed trauma system and ought to answer a lot of these questions.

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