Trial reportThe journal of trauma and acute care surgery2022
Prehospital synergy: Tranexamic acid and blood transfusion in patients at risk for hemorrhage.
Trial report in The journal of trauma and acute care surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
7 citing papers in PubMed, 3 syntheses or guidelines pooled it, 19 citations in OpenAlex.
- Tranexamic acid in trauma: A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT.The journal of trauma and acute care surgery · 2025Guideline
- Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement.World journal of emergency surgery : WJES · 2025Pooled it
- Prehospital tranexamic acid decreases early mortality in trauma patients: a systematic review and meta-analysis.Frontiers in medicine · 2025Pooled it
- Bayesian Statistics to Reanalyze Data From the STAAMP Trial.JAMA network open · 2026Trial
- Prehospital Blood Administration in Traumatic Hemorrhagic Shock.Journal of the American College of Emergency Physicians open · 2025Article
- Prehospital Tranexamic Acid Combined with Blood Transfusion Reduced the Short-Term Mortality Risk in Trauma Patients at Risk for Hemorrhage.Therapeutics and clinical risk management · 2025Article
- Review
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Authors and funding
12 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundGrowing evidence supports improved survival with prehospital blood products. Recent trials show a benefit of prehospital tranexamic acid (TXA) administration in select subgroups. Our objective was to determine if receiving prehospital packed red blood cells (pRBC) in addition to TXA improved survival in injured patients at risk of hemorrhage.
methodsWe performed a secondary analysis of all scene patients from the Study of Tranexamic Acid during Air and ground Medical Prehospital transport trial. Patients were randomized to prehospital TXA or placebo. Some participating EMS services utilized pRBC. Four resuscitation groups resulted: TXA, pRBC, pRBC+TXA, and neither. Our primary outcome was 30-day mortality and secondary outcome was 24-hour mortality. Cox regression tested the association between resuscitation group and mortality while adjusting for confounders.
resultsA total of 763 patients were included. Patients receiving prehospital blood had higher Injury Severity Scores in the pRBC (22 [10, 34]) and pRBC+TXA (22 [17, 36]) groups than the TXA (12 [5, 21]) and neither (10 [4, 20]) groups (p < 0.01). Mortality at 30 days was greatest in the pRBC+TXA and pRBC groups at 18.2% and 28.6% compared with the TXA only and neither groups at 6.6% and 7.4%, respectively. Resuscitation with pRBC+TXA was associated with a 35% reduction in relative hazards of 30-day mortality compared with neither (hazard ratio, 0.65; 95% confidence interval, 0.45-0.94; p = 0.02). No survival benefit was observed in 24-hour mortality for pRBC+TXA, but pRBC alone was associated with a 61% reduction in relative hazards of 24-hour mortality compared with neither (hazard ratio, 0.39; 95% confidence interval, 0.17-0.88; p = 0.02).
conclusionFor injured patients at risk of hemorrhage, prehospital pRBC+TXA is associated with reduced 30-day mortality. Use of pRBC transfusion alone was associated with a reduction in early mortality. Potential synergy appeared only in longer-term mortality and further work to investigate mechanisms of this therapeutic benefit is needed to optimize the prehospital resuscitation of trauma patients. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.
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