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Prehospital TXA helps fibrinolytic shutdown
Survival benefit of prehospital TXA in fibrinolytic shutdown: Insights from two prospective trauma trials
The Journal of Trauma and Acute Care Surgery · 2026-10-09 · Added 11 October 2026
Pooled analysis of two prospective prehospital TXA trials found fibrinolytic shutdown carried 14.5% 30-day mortality versus 6.5% with physiological fibrinolysis, and shutdown patients randomised to TXA had about a third the risk of death.
- Study type
- Other
- Design
- Pooled analysis of two prospective prehospital TXA RCTs
- Participants
- 1,249 trauma patients
- Main finding
- 30-day mortality 14.5% with fibrinolytic shutdown vs 6.5% physiological fibrinolysis; TXA in shutdown patients was associated with lower risk of death (HR 0.32, 95% CI 0.11–0.91); hyperfibrinolysis independently predicted death (HR 2.87, 95% CI 1.10–7.53)
- Caveat
- Subgroup analysis of pooled trials, with the TEG fibrinolysis phenotype measured on hospital arrival rather than prehospital
- Bottom line
- Hypothesis-generating
Why it matters in Australia (High relevance). Prehospital TXA for major trauma is carried by nearly all Australian ambulance services, so this speaks directly to current practice — even though the fibrinolysis testing itself stays an in-hospital tool for now.
Learning goal
Weigh the evidence for giving TXA prehospital to trauma patients with suspected fibrinolytic shutdown.
More
- Topic: Trauma
- Daily scan: 11 October 2026
- Podcast: Paramedic Papers Daily, 11 October 2026
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