Tranexamic acid in trauma: How should we use it?

T CRASH-2 trial results have prompted trauma centers to contemplate whether tranexamic acid (TXA) should be added to their armamentarium for the treatment of bleeding trauma patients. Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma (ACOT). Furthermore, some studies have documented that the risk of death in trauma correlates significantly with fibrinolysis. The presence of hyperfibrinolysis (HF) in patients with severe traumatic injuries is associated with a high mortality rate (70Y100%). The use of antifibrinolytic agents in the treatment of the ACOT therefore has significant biologic plausibility. We will review the current knowledge of fibrinolysis in trauma and studies of antifibrinolytic agents to make evidencebased recommendations regarding TXA use in trauma systems with mature hemostatic resuscitation protocols for the treatment of hemorrhagic shock patients.

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