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.

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.

Trauma, Injury, Hemorrhage, Shock, Tranexamic acid, TXA, Blood products, LMIC, South Africa

Abstract
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.

Chelsea Dymond1

, Mengli Xiao2
, Lani Finck3
, Hendrick Lategan4

, George Oosthuizen4

, Shaheem de Vries5
,

Janette Verster6

, Craig Wylie7

, EpiC Study Site Collaborators8

, Willem Stassen9

, Joseph Maddry10, Steven Schauer11,

Julia Dixon3
and Nee-Kofi Mould-Millman3*

2025

Peri Irawan

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