To the Editor As Guyette and colleagues1 report, prehospital administration of tranexamic acid (TXA) in injured patients at risk for hemorrhage is safe and associated with lower 30-day mortality in specific subgroups of patients. However, some results require further explanation.
First, patients with a Glasgow Coma Scale score of 3 or lower or bilateral unreactive pupils at baseline were not excluded in the trial. Regardless of receiving TXA or placebo, most of these patients have a very poor prognosis after the prespecified sensitivity analysis in the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial.2 Therefore, their inclusion in the trial might bias the efficacy of TXA toward the null.
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Zhang S, Xiao C, Gao Z. Prehospital Tranexamic Acid Administration in Injured Patients. JAMA Surg. 2021;156(7):688. doi:10.1001/jamasurg.2021.0251
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