Does TXA reduce total volume of 24-hour blood products transfused in post-traumatic hemorrhage in a resource-constrained setting:Secondary analysis of a prospective cohort trauma study in South Africa.

Background: Low- and middle-income countries bear a disproportionately large share of the global burden of trauma, with hemorrhage as a leading cause of preventable mortality. Tranexamic acid has been shown to reduce mortality in trauma, but no studies have investigated tranexamic acid's effect on blood product consumption in resource-constrained settings.

Methods: A prospective secondary analysis was performed from data collected from 'The Epidemiology and Outcomes of Prolonged Trauma Care (EpiC)' study, a multicenter observational study of major trauma patients within the Western Cape of South Africa. Adult trauma patients with major hemorrhage who arrived at an EpiC study site within 24 h of injury between March 2021 and December 2024 were included. The primary outcome was total blood product administration within 24 h of injury. Treatment groups included patients who received tranexamic acid within 3 h compared to those who did not. Multiple regression with inverse probability weighting was performed to mitigate confounding. Subgroup analyses included patients with penetrating injuries, severe shock, presence of intracranial hemorrhage and patients without head injury who received large-volume blood products.

Results: A total of 1630 patients were included. Median total blood product volume was 760 mL. There was no difference in blood volume between the two groups. There was no significant difference in blood product volumes observed in all subgroup analysis.

Conclusion: In a cohort of adult trauma patients with major hemorrhage, there was no difference in total blood volume transfused within the first 24 h between patients who received tranexamic acid compared to those who did not.