Is a tranexamic acid bolus alone enough in trauma?

Design

Retrospective cohort with 1:1 propensity score matching, single trauma centre

Population

1408 adult trauma patients given TXA within three hours of injury (335 matched pairs)

Primary outcome

In-hospital, 24-hour and 28-day mortality

Effect

In-hospital mortality 14.0% vs 17.3% (adjusted odds ratio 1.29, 95% CI 0.84 to 1.97)

The CRASH-2 regimen gives a 1-g tranexamic acid (TXA) bolus then a 1-g infusion over eight hours, but the maintenance infusion is awkward to run during early resuscitation. This single-centre study compared a bolus-only approach with the full bolus-plus-infusion regimen in trauma patients given TXA within three hours of injury.

After 1:1 propensity matching of 335 pairs, mortality did not differ significantly: in-hospital 14.0% versus 17.3% (adjusted odds ratio 1.29, 95% CI 0.84 to 1.97), with similar results at 24 hours and 28 days. On the face of it, the bolus alone performed comparably.

The caution is in the detail. This is retrospective and underpowered, and all three adjusted odds ratios sit above 1.0, numerically favouring the full regimen even though none reached significance. It is reasonable reassurance where an infusion genuinely cannot be given, but not yet a reason to abandon the maintenance dose; prospective trials are needed.

• Propensity-matched comparison of 1-g TXA bolus alone versus bolus-plus-infusion in trauma, 335 matched pairs.
• In-hospital mortality 14.0% versus 17.3% (adjusted odds ratio 1.29, 95% CI 0.84 to 1.97), not significant.
• No significant difference at 24 hours or 28 days either.
• All point estimates numerically favoured the full regimen, and the study was underpowered.
• Reasonable where an infusion cannot be delivered, but not a reason to drop the maintenance dose.

Why it matters

It speaks to a real bedside problem, the hard-to-run infusion in early trauma care, without settling whether skipping it is safe.

Don't overread it

This was retrospective, single-centre and underpowered; it suggests comparability, it does not demonstrate that the bolus alone is equivalent.

The statistics, in plain English

A non-significant result in a small study does not prove the two regimens are equal; the confidence intervals are wide and the point estimates lean towards the infusion, so this cannot establish non-inferiority.

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