Prehospital Tranexamic Acid Combined with Blood Transfusion Reduced the Short-Term Mortality Risk in Trauma Patients at Risk for Hemorrhage.

Background: Hemorrhage is a leading cause of preventable death in trauma. While both blood transfusion and tranexamic acid (TXA) improve outcomes, the combined effect of prehospital TXA and transfusion remains uncertain. This study aims to evaluate the impact of prehospital TXA combined with blood transfusion on short-term mortality in trauma patients at risk for hemorrhage. Methods: We performed a retrospective cohort study of 408 adult trauma patients at risk for hemorrhage admitted between 2018 and 2023. Patients were grouped into transfusion only (n=240) or prehospital TXA plus transfusion (n=168). The primary outcome was 30-day mortality. Secondary outcomes included 24-hour mortality, transfusion requirements, multiple organ failure (MOF), and venous thromboembolism (VTE). Results: Compared with transfusion alone, prehospital TXA plus transfusion significantly reduced 30-day mortality (14.3% vs 31.3%, p<0.01) and 24-hour mortality (6.0% vs 19.6%, p<0.01). The TXA group also had lower MOF incidence (14.3% vs 28.7%, p<0.01) and required less plasma and crystalloid resuscitation, without an increase in VTE (p=0.17). Kaplan-Meier analysis confirmed a survival advantage (log-rank p<0.01), and multivariate Cox regression identified combination therapy as an independent predictor of reduced 30-day mortality (HR=2.16, 95% CI: 1.35-3.46, p<0.01). Conclusion: Prehospital TXA combined with transfusion significantly improves short-term survival and reduces organ failure in bleeding trauma patients, without increasing thromboembolic risk. These findings support early integration of TXA into prehospital transfusion protocols.