Abstract
ABSTRACT
Background
The CRASH‐2 regimen for tranexamic acid (TXA) consists of a 1‐g intravenous bolus followed by a 1‐g infusion over 8 hours. The maintenance infusion may be challenging to administer during the early phase of trauma resuscitation. We compared mortality outcomes between patients receiving a 1‐g TXA bolus alone and those receiving a bolus‐plus‐infusion regimen.
Methods
We conducted a retrospective cohort study of adult trauma patients (≥ 19 years) who presented directly to the trauma bay at a regional trauma center between July 2018 and December 2023. Patients who received TXA within 3 hours of injury were included in the inter‐regimen analysis and categorized into either a 1‐g bolus‐only group or a 1‐g bolus plus 1‐g infusion group. Clinical outcomes were compared using multivariable logistic regression. To minimize selection bias and baseline imbalances, 1:1 propensity score matching was performed, followed by McNemar testing and conditional logistic regression analyses in the matched cohort.
Results
Among 5204 eligible patients, 1787 received TXA. The primary inter‐regimen cohort included 1408 patients treated within 3 hours of injury: 409 received bolus‐only TXA and 999 received bolus‐plus‐infusion TXA. Propensity score matching yielded 335 pairs. After matching, mortality did not differ significantly between the groups: in‐hospital mortality 14.0% versus 17.3% (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 0.84–1.97;
p
= 0.240), 24‐h mortality 4.5% versus 5.1% (aOR, 1.13; 95% CI, 0.57–2.27;
p
= 0.724), and 28‐day mortality 9.3% versus 11.9% (aOR, 1.36; 95% CI, 0.81–2.28;
p
= 0.243).
Conclusions
In this single‐center retrospective cohort study, a 1‐g TXA bolus alone was associated with mortality outcomes comparable to those of the conventional bolus‐plus‐infusion regimen among patients treated within 3 hours of injury. Prospective studies are warranted to validate these findings.