The critical role of tranexamic acid for bleeding patients.

Tranexamic acid (TXA) is an essential life-saving medicine that prevents clot breakdown in patients who are haemorrhaging from trauma, childbirth, surgery and other causes. While TXA is inexpensive, it is not widely used, especially in low- and middle-income countries, which also experience challenges in the domains of blood collection, testing, storage and transfusion. TXA has been extensively studied for the treatment of traumatic, obstetric and surgical bleeding, and landmark trials have repeatedly demonstrated its safety, efficacy and life-saving potential, especially when given early (within 3 h of the inciting event). Among trauma patients with blunt and penetrating injuries as well as head trauma, TXA decreases the risk of mortality and is also cost effective. Among women with postpartum haemorrhage, TXA decreases the risk of death due to bleeding, and has been successfully implemented as part of a bundled response. Among surgical patients across sub-specialties, TXA decreases the risk of mortality and even decreases the need for blood product transfusion. Furthermore, these trials have shown that TXA does not increase the risk of adverse events such as thrombosis or seizure. We encourage the global community to shift its focus from further trials to the development of standardized implementation protocols, which have been shown to increase TXA use in both high- and low-resource settings. Expansion of TXA availability and use in global blood deserts will help bridge the gap for haemorrhaging patients who are at risk of death and disability from injury, childbirth or surgical bleeding.