# Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis

## TL;DR

This study finds that prehospital use of tranexamic acid (TXA) is low in a Swiss region, especially among women and older patients, despite guidelines recommending its early use for injured patients.

## Contribution

The study provides a sex- and age-disaggregated analysis of prehospital TXA administration in a real-world setting, revealing disparities in treatment rates.

## Key findings

- Only 11% of high-risk injured patients received prehospital TXA, with treatment rates increasing with higher risk of death from bleeding.
- Women and elderly patients were less likely to receive TXA, regardless of injury severity or risk level.
- TXA administration rates were below guideline recommendations, suggesting undertreatment in the prehospital setting.

## Abstract

Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The aim of this study was to assess the prehospital administration of TXA for injured patients in a Swiss region.

We conducted a retrospective observational study in Switzerland between 2018 and 2021. Inclusion criteria were injured patients ≥18 years for whom an ambulance or helicopter was dispatched. The exclusion criterion was minor injury defined by a National Advisory Committee for Aeronautics score <3. The primary outcome was the proportion of patients treated with TXA according to guidelines. The European guidelines were represented by the risk of death from bleeding (calculated retrospectively using the Bleeding Audit for Trauma and Triage (BATT) score). Factors impacting the likelihood of receiving TXA were assessed by multivariate analysis.

Of 13 944 patients included in the study, 2401 (17.2%) were considered at risk of death from bleeding. Among these, 257 (11%) received prehospital TXA. This represented 38% of those meeting US guidelines. For European guidelines, the treatment rate increased with the risk of death from bleeding: 6% (95% CI 4.4% to 7.0%) for low risk (BATT score 3–4); 13% (95% CI 11.1% to 15.9%) for intermediate risk (BATT score 5–7); and 21% (95% CI 17.6% to 25.6%) for high risk (BATT score ≥8) (p<0.01). Women and the elderly were treated less often than men and younger patients, irrespective of the risk of death from bleeding and the mechanism of injury.

The proportion of injured patients receiving TXA in the prehospital setting of the State of Vaud in Switzerland was low, with even lower rates for women and older patients. The reasons for this undertreatment are probably multifactorial and would require specific studies to clarify and correct them.