Uncritical use of tranexamic acid in trauma patients. Do no further harm!

Based upon the results of CRASH-2, early administration of antifibrinolytic tranexamic acid (TXA) is recommended in bleeding trauma patients or trauma patients presumed to bleed. Many trauma centers and emergency medical services have adopted this practice into their routine algorithms. The pitfalls of CRASH-2 have been discussed in the literature, but the positive effects could sometimes not be reproduced in follow-up studies. The mechanism of action of TXA in trauma is still not clear and major knowledge gaps with TXA in the context of trauma have been identified. Component analyses have indicated different phenotypes of fibrinolytic disturbances after trauma upon emergency department admission with fibrinolytic "shutdown" potentially representing the most prominent and frequent phenotype (64 %). Viscoelastic tests, e.g. ROTEM (R), are currently the best method to assess fibrinolytic phenotype in the acute phase and may support more selective TXA administration and therapies in trauma.