Background Trauma is one of the leading causes of death worldwide. Tranexamic acid (TXA) has shown effectiveness in reducing hemorrhage-related mortality in a hospital setting. However, its application in the prehospital setting still presents challenges.

Aim To determine the efficacy and safety of TXA administered in the prehospital setting in trauma patients.

Methods A systematic review with meta-analysis was conducted. PRISMA guidelines were followed.Randomized clinical trials evaluating the administration of TXA in the prehospital setting in trauma patients aged 18 years or older were included. Studies were assessed by two reviewers independently. The GRADE approach was used to assess the quality of evidence and ROB2 to identify the risk of bias. Results were analyzed by meta-analysis, using fixed or random effects models, depending on the heterogeneity observed.

Results A total of 979 records were identified; PubMed (149), Embase (565), Cochrane (29) and Scopus (236). Three studies were included. After analysis TXA reduced mortality in the first 24 hours (RR 0.74, 95% CI: 0.56-0.97; P = 0.03) and at 28 days (RR 0.82, 95% CI: 0.69-0.98; P = 0.03). No improvement in survival with favorable long-term functional outcome was observed (RR 1.11, 95% CI: 0.91-1.35; P = 0.29). No significant differences were found in adverse events such as deep vein thrombosis (RR 1.23, 95% CI: 0.96-1.58; P = 0.11), pulmonary embolism (RR 1.08, 95% CI: 0.76-1.53; P = 0.66) or myocardial infarction (RR 2.17, 95% CI: 0.75-6.31; P = 0.15).

Conclusions Prehospital TXA use in trauma patients reduces short-term mortality, mortality in the first 24 hours, and mortality at 28 days. In addition, it does not increase the risk of serious adverse events; deep vein thrombosis, pulmonary embolism, myocardial infarction, or ischemic stroke.

The authors have declared no competing interest.

This study did not receive any funding

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