The trauma is the leading cause of death, with most deaths associated with traumatic brain injury or hemorrhage. TXA is an antifibrinolytic agent (1). According to the CRASH-2 and CRASH-3 trials, the use of TXA within 3 h post-trauma significantly reduces mortality rates (2). Additionally, TXA use is associated with a reduced risk of death within 24 h (3). Although the use of TXA may increase the risk of venous thromboembolism events, this risk does not significantly increase with the administration of a single loading dose (1). Despite the effectiveness of TXA in trauma management being confirmed by multiple studies (4, 5), its use in pre-hospital settings remains inadequate. In the UK, only about 5% of severely injured patients receive TXA treatment during the pre-hospital phase (6). Therefore, further research aims to raise awareness of TXA use, thereby optimizing the trauma management strategies and ultimately reducing mortality in trauma patients (7). Consequently, TXA has significant clinical implications in the management of trauma patients in emergency care.

The TXA is a synthetic antifibrinolytic agent that inhibits the degradation of fibrin, enhances clot formation, and reduces the incidence of the trauma-induced coagulopathy. Its mechanism of action primarily involves competitively blocking the lysine binding sites on plasminogen, thus inhibiting its interaction with formed fibrin and plasmin, which slows down the degradation of fibrin. In the trauma management, TXA has been widely applied in various bleeding situations, particularly showing significant effects in early interventions for severely injured patients (8).

Trauma-Induced Coagulopathy (TIC) is a coagulopathy associated with a systemic inflammatory state, often accompanied by acidosis and hypothermia, occurring in about 25% of severely injured patients. Its incidence is directly related to the severity of the trauma (9). In this context, the application of TXA can effectively improve coagulation function and reduce mortality. Studies have shown that early use of TXA can significantly enhance survival rates in severely injured patients without increasing the risk of thrombotic events (8).

Additionally, the anti-inflammatory effects of the TXA play an important role in the trauma management. Recent studies have indicated that, beyond its antifibrinolytic properties, the TXA also possesses anti-inflammatory and anti-angiogenic characteristics, which may enable it to play a broader role in the recovery and regeneration processes after trauma (10).

In summary, the TXA has become an important drug in the trauma management through its antifibrinolytic effects and modulation of coagulation, effectively reducing the risk of bleeding and improving patient survival rates. As research into the mechanisms of TXA continues, its potential in clinical applications will be further explored.

TXA in trauma patients is increasingly gaining attention, particularly in various clinical settings. Studies have shown that TXA can significantly reduce blood loss and the need for transfusions in trauma patients.

In trauma patients, the CRASH-3 trial indicated that early administration of TXA can lower mortality and disability rates in patients with traumatic brain injury. The trial included all patients with traumatic brain injuries and found that those who received tranexamic acid (TXA) within 8 h post-injury had a significantly reduced overall mortality rate (2). Additionally, TXA has shown positive effects in reducing the need for reoperation in trauma patients (11). Kaur et al. (12) found in their study on patients with lower limb injuries that those who received 1 g of TXA had significantly lower transfusion requirements after surgery compared to those who did not receive TXA, further supporting its use in reducing surgical bleeding and enhancing patient safety.

Moreover, the use of TXA has been associated with a reduction in the incidence of complications in trauma patients, further improving overall treatment outcomes. For example, Ghanem et al. (13) suggest that while tranexamic acid (TXA) demonstrates efficacy in reducing bleeding, further research is necessary to fully assess its potential for cytotoxic effects, particularly at high concentrations. They advocate for cautious use of TXA in cosmetic surgery, emphasizing careful patient selection and the utilization of lower concentrations and shorter treatment durations. Additionally, Aleman Paredes et al. (14) noted in their study on burn reconstruction that TXA may have potential applications in post-trauma recovery, particularly during autologous skin grafting procedures. These research findings demonstrate that TXA yields positive effects across different types of trauma, effectively reducing blood loss and transfusion needs, and showcasing its broad clinical application potential. In summary, the TXA exhibits promising effects in various types of trauma, effectively lowering blood loss and the need for transfusions, with extensive clinical application potential.

The method of administration and dosage of the TXA significantly impact its efficacy. In clinical practice, TXA can be administered intravenously or orally, among other routes. Studies have shown that intravenous administration is more effective in acute trauma patients.

In the treatment of acute trauma, intravenous administration of TXA demonstrates clear advantages. Dewan et al. (2) indicated that TXA can reduce the need for blood transfusions in surgical patients, which is also applicable to trauma patients. Patients receiving intravenous TXA showed significantly reduced blood loss and lower reoperation rates. According to the CRASH-3 trial, the recommended dosage of TXA is a loading dose of 1 g, followed by a maintenance dose of 1 g within 8 h, and this regimen has been effective in reducing mortality rates (2, 11).

On the other hand, the oral administration of the TXA has also been evaluated in some studies. Although oral TXA has shown some effectiveness in controlling postoperative bleeding, its effects are relatively weaker compared to intravenous administration. Therefore, intravenous administration is generally considered the preferred approach in the management of acute trauma patients.

Additionally, the choice of TXA dosage directly influences its effectiveness. Research indicates that TXA dosages vary in different clinical settings. For example, in cesarean sections and vaginal deliveries, the dosage of TXA is adjusted based on the patient's weight and clinical conditions (7, 15). In Gurleen Kaur's study, administering 1 g of TXA significantly reduced blood loss and transfusion requirements (12). Furthermore, the research by Kaur et al. also showed that TXA effectively decreases the need for transfusions in trauma patients, further supporting the importance of TXA in the trauma management (12). Therefore, appropriate administration methods and dosage selection are crucial for the clinical effectiveness of TXA.

Overall, the method of administration and dosage of the TXA significantly influence its efficacy, with intravenous administration typically preferred over oral administration. Rational dosage selection helps optimize its application outcomes in various the trauma management scenarios.

The TXA is a synthetic antifibrinolytic agent that has been shown to effectively reduce blood loss and transfusion requirements in trauma patients. According to a systematic review and meta-analysis by Ker et al. (11) TXA can reduce the probability of receiving a blood transfusion by one-third. Additionally, Jiang et al. proposed in a retrospective study that rapidly assessing the severity of multiple trauma patients is crucial for improving patient outcomes. Their research indicated that the Modified Early Warning Score (MEWS) and the Circulation, Respiration, Abdomen, Motor, and Speech Score (CRAMS) are significantly effective in predicting in-hospital mortality and trauma severity (16). In summary, TXA demonstrates good efficacy in reducing blood loss and transfusion needs in trauma patients and is widely applied in the trauma management.

The research findings regarding TXA's role in increasing survival rates and improving prognoses for trauma patients show positive trends. A systematic review and bias-adjusted meta-analysis by Fouche et al. indicated that the use of TXA reduced the risk of death at 1 month by 11%, with a more pronounced survival advantage in patients receiving TXA outside the hospital (3). Moreover, Zwicker pointed out that TXA's application in various clinical settings effectively reduces bleeding risk, although its efficacy may be less than expected in certain specific cases, such as in patients with thrombocytopenia (17).

Franchini and Mannucci's (8) commentary noted that early administration of TXA in severe trauma can significantly improve survival rates without increasing the risk of thromboembolic events, which is confirmed by the CRASH-2 and CRASH-3 trials. Additionally, research by Mutschler et al. (18) suggests that utilizing the heart rate to systolic blood pressure ratio (Shock Index) allows for better assessment of hypovolemic shock in trauma patients; combining this with early TXA administration may improve overall patient prognosis. Further studies have shown that low molecular weight heparin (LMWH) is also associated with reduced mortality risk in elderly patients with severe traumatic brain injuries, supporting the application of TXA in older patients (19). The CRASH-3 trial indicated that early administration of TXA can reduce mortality and disability risk in patients with traumatic brain injury (2). This finding aligns with Bouras et al.'s (20) perspective on the safe and effective use of TXA in trauma, obstetrics, and other high-risk bleeding surgeries. Another study highlighted the application of TXA in burn reconstruction, particularly in comparisons between autologous skin grafts and bioengineered skin substitutes, indicating that the TXA may have a positive impact on functional and aesthetic outcomes (14).

Tranexamic acid (TXA) has emerged as a pivotal therapeutic agent in trauma management, demonstrating significant potential in reducing mortality, blood loss, and transfusion requirements. Evidence from landmark trials such as CRASH-2 and CRASH-3 underscores the importance of early administration, particularly within 3 h post-injury, to maximize its efficacy. TXA's antifibrinolytic and anti-inflammatory properties further enhance its role in stabilizing clot formation and improving patient outcomes. However, its underutilization in pre-hospital settings and variability in clinical application highlight the need for increased awareness, standardized protocols, and further research.

Future directions should focus on developing individualized treatment plans, exploring alternative administration routes, and investigating the combined use of TXA with other therapies. Additionally, prospective clinical trials targeting specific populations and long-term safety assessments are essential to optimize its application. By addressing these gaps, TXA can be more effectively integrated into trauma care, ultimately reducing morbidity and mortality associated with hemorrhage and traumatic injuries. This review underscores the critical role of TXA in trauma management and emphasizes the importance of continued research to unlock its full clinical potential.

The risk of bias assessment reveals high risk in random sequence generation due to unclear randomization in studies like CRASH-2 and CRASH-3, with observational studies inherently lacking randomization. Attrition bias is moderate, as some studies have rigorous follow-up, but observational studies may have missing data. Reporting bias is also moderate, with CRASH trials well-documented but other studies potentially omitting outcomes. Study heterogeneity shows CRASH-2 and CRASH-3, as high-quality RCTs, consistently demonstrate TXA's effectiveness in reducing mortality within 3 h post-trauma, while Ker et al.'s systematic review and observational studies show variability due to design and confounding factors. Evidence quality is high for RCTs due to robust design, low bias, consistency, directness, and precision, whereas observational studies are rated low to moderate due to potential bias, inconsistency, and smaller sample sizes.