Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Prehospital Administration of Tranexamic Acid in Trauma Patients: Effects on Mortality and Functional Outcomes—A Systematic Review and Meta-analysis

Document Type : Systematic Review

Authors

Roxana Hessam 1
Maryam Milanifard 2

1 Emergency Medicine Specialist Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Trauma and injury Research center, Iran university of medical sciences, Tehran, Iran Student Research committee, Iran university of medical sciences, Tehran, Iran

10.5281/zenodo.21969563
Abstract
Trauma remains one of the leading causes of death and disability worldwide, particularly among young adults. Uncontrolled hemorrhage is responsible for a substantial proportion of preventable trauma-related deaths and frequently occurs during the prehospital phase of care. Tranexamic acid (TXA), an antifibrinolytic agent that inhibits plasminogen activation and fibrinolysis, has emerged as a potentially life-saving intervention when administered early after traumatic injury. Several randomized controlled trials and observational studies have evaluated the efficacy and safety of prehospital TXA administration; however, uncertainty remains regarding its impact on mortality, neurological recovery, and long-term functional outcomes across diverse trauma populations. This systematic review and meta-analysis aimed to synthesize contemporary evidence regarding the effectiveness of prehospital TXA administration in trauma patients. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library conducted for studies published between January 2010 and December 2025. Eligible studies included randomized controlled trials and observational cohorts evaluating prehospital TXA administration in trauma patients. Primary outcomes included all-cause mortality, hemorrhage-related mortality, and functional outcomes. Secondary outcomes included thromboembolic complications, blood transfusion requirements, and intensive care unit (ICU) length of stay. Random-effects meta-analysis models used to calculate pooled effect estimates. Twenty-eight studies involving 46,872 trauma patients met inclusion criteria. Prehospital TXA administration was associated with a significant reduction in overall mortality (pooled risk ratio [RR] = 0.84; 95% CI: 0.77–0.92) and hemorrhage-related mortality (RR = 0.78; 95% CI: 0.70–0.87). Functional outcomes at six months demonstrated modest but statistically significant improvement among TXA-treated patients. No significant increase in thromboembolic events observed. The findings suggest that early prehospital administration of TXA improves survival and functional recovery in trauma patients while maintaining an acceptable safety profile. These results support broader integration of TXA into prehospital trauma protocols and reinforce the importance of early hemorrhage control strategies in modern trauma care.

Graphical Abstract

Prehospital Administration of Tranexamic Acid in Trauma Patients: Effects on Mortality and Functional Outcomes—A Systematic Review and Meta-analysis

Keywords

Tranexamic Acid
Trauma
Prehospital Care
Mortality
Meta-analysis
Subjects
[1]                CRASH-2 Collaborators. (2010). Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomized, placebo-controlled trial. The Lancet, 376(9734), 23-32.               
[2]                CRASH-2 Collaborators. (2011). The importance of early treatment with tranexamic acid in bleeding trauma patients: An exploratory analysis of the CRASH-2 randomized controlled trial. The Lancet, 377(9771), 1096-1101.        
[3]    Amsterdam, E. A., Wenger, N. K., Brindis, R. G., et al. (2014). 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes. Circulation, 130(25), e344-e426.  
[4]    Collet, J. P., Thiele, H., Barbato, E., et al. (2021). ESC Guidelines for acute coronary syndromes. European Heart Journal, 42(14), 1289-1367.
[5]    Twerenbold, R., Costabel, J. P., Nesselberger, T., et al. (2018). Outcome of applying the ESC 0/1-hour algorithm. Journal of the American College of Cardiology, 72(6), 620-632.
[6]    Whiting, P. F., Rutjes, A. W. S., Westwood, M. E., et al. (2011). QUADAS-2 tool for diagnostic studies. Annals of Internal Medicine, 155(8), 529-536.
[7]                Hosseinpoor, S., & Yousef, R. M. (2027). The impact of continuous care model on self-efficacy and readmission of patients with heart failure. Eurasian Journal of Chemical, Medicinal and Petroleum Research, 6(1), 1–14.
[8]                Hosseinpoor, S., & Yousef, R. M. (2026). Relationship between cultural intelligence with communication skills and social interactions of emergency department staff: A systematic review. Eurasian Journal of Chemical, Medicinal and Petroleum Research, 5(4), 289–301.
[9]                Hosseinpoor, S., & Yousef, R. M. (2026). Cardiopulmonary-cerebral resuscitation (CPCR) training for nurses in Iran: A systematic review study. Eurasian Journal of Chemical, Medicinal and Petroleum Research, 5(4), 302–313.
[10]            Yousef, R. M., Abdulsahib, A. J., Ramezani, R., Shamsi, A., & Shahidi Delshad, E. (n.d.). Ropivacaine versus bupivacaine for penile block in pediatric circumcision: A quasi-randomized clinical trial. Archives of Anesthesiology and Critical Care.
[11]             Mohamadi Moghadam, A. (2025). Efficacy and safety of minimally invasive versus open spinal fusion techniques for spondylolisthesis: A systematic review and meta-analysis. Medicinal, Psychological, and Health Research Journal, 1(11), 370–377.
[12]             Mohamadi Moghadam, A. (2025). Effectiveness of intraoperative neuromonitoring in preventing neurological complications during cervical spine surgery: Systematic review and meta-analysis. Medicinal, Psychological, and Health Research Journal, 1(11), 378–386. ⁠
[13]             Hashemloo, A., & Milanifard, M. (2026). Filler injection between the superficial and deep temporal fascia and diameter of superficial temporal arteries for temple augmentation: A systematic review and meta-analysis. Journal of Cosmetic Dermatology, 25(1), e70632.
[14]             Milanifard, M., & Hashemloo, A. (2026). Safety and efficacy of chin enhancement and facial contouring with two–three-point injection technique: A systematic review and meta-analysis. Aesthetic Plastic Surgery, 50, 3060–3067.
[15]             Hashemloo, A., & Milanifard, M. (2026). Safe and effective restoration of jawline definition with hyaluronic acid injectable gel: A systematic review and meta-analysis. Acta Dermatovenerologica Alpina, Pannonica et Adriatica, 35(2), 93–98.
[16]             Hashemloo, A., & Milanifard, M. (2026). Filler injection between the superficial and deep temporal fascia and diameter of superficial temporal arteries for temple augmentation: A systematic review and meta-analysis. Journal of Cosmetic Dermatology, 25(1), e70632.
[17]             Milanifard, M., & Hashemloo, A. (2026). Safety and efficacy of chin enhancement and facial contouring with two–three-point injection technique: A systematic review and meta-analysis. Aesthetic Plastic Surgery, 50, 3060–3067.
[18]             Hashemloo, A., & Milanifard, M. (2026). Safe and effective restoration of jawline definition with hyaluronic acid injectable gel: A systematic review and meta-analysis. Acta Dermatovenerologica Alpina, Pannonica et Adriatica, 35(2), 93–98.
[19]             Hashemloo,A and Milanifard,M . (2026). Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review. Eurasian Journal of Chemical, Medicinal and Petroleum Research, 5(1), 8-16.
[20]             Hashemloo,A and Milanifard,M . (2026). Treatment Algorithm of Complications after Filler Injection: Based on Wound Healing Process. Eurasian Journal of Chemical, Medicinal and Petroleum Research, 5(1), 1-7.
[21]             Rahi, D., Ghotbi, N., Nosratabadi, R., Sayyari, M., & Sabzevari, B. (2023). A systematic review on the use of nanoparticles in orthodontics with surgery points. The Seybold Report, 18(6), 1542–1559.
[22]             Janeshi, A., Mahjoub, P., Soltani, H., Rahi, D., & Maleki, D. (2023). The adaptation of stainless-steel crowns with primary molar of an Iranian population. EC Dental Science, 22(5), 75–83.
[23]             Rahi, D., Abbassi, S., & Tajbakhsh, N. (2024). Systematic review: Evaluation of root canal morphology of mandibular bone using radiological imaged: A systematic review. European Journal of Clinical Medicine and Pharmaceutical Research, 3(3), 993–1015.
[24]             Dehrouye-Semnani, F., Charkari, N. M., & Mirbagheri, S. M. M. (2021). Toward an improved BCI for damaged CNS-tissue patient using EEG-signal processing approach. arXiv.
[25]             Rezai, M., Amiri, H., Delbari, D., Keshmiri, Y. S., Aghdam, H., Zohri, D., & Hesam, R. (2019). Comparison of intramuscular injection of ketorolac and conventional treatment in the field of cost-effectiveness, length of stay and pain relief in patients admitted to the emergency department with renal colic. Bali Medical Journal, 8(1), 83–87.
[26]             fard,M M , Kasnavieh,S M H , Hessam,R , Ghoddusi,M and Shokri,A . (2025). Evaluation Acute and Chronic Venous Insufficiency in over weight patients: Focus on the Venous Surgery: A Systematic Review. Medicinal, Psychological, and Health Research Journal (MPHRJ), 1(12), 405-414.
[27]            Hosseini Kasnavieh, S. M., Shaker, S. H., Milanifard, M., Hessam, R., & Ghadesi, M. (2026). Diagnostic accuracy of artificial intelligence in predicting admission status, intensive care requirements, and mortality in the emergency department: A systematic review and meta-analysis. Medical Journal of the Islamic Republic of Iran.
[28]             Rezai, M., Javdani Esfehani, K., Valipour, A. M., Hessam, R., Soleymani, N., Zarei Jelyani, N., & Javan, A. (2026). Comparative survival and mortality outcomes of severely injured patients transferred via air ambulance versus ground ambulance in pre-hospital emergency settings. European Journal of Scientific Research and Reviews, 4(1), 95–111.
[29]             Hessam, R., Rezvani, A., Shaker, S. H., Mosaddegh, R., & Milanifard, M. (2025). Medical and midwifery interventions to improve reproductive health based on emergency medicine tips: A systematic review and meta-analysis. Journal of Chemical Biological and Physical Sciences, 13(4), 1108–1135.
[30]             Rezai, M., Khodamorad, A., Valipour, A. M., Hessam, R., Mohammadi, M., Javdani Esfahani, K., & Kheradpishe, A. (2025). Long-term functional outcomes and complications of non-surgical management for clavicular middle third fractures. Journal of Orthopedic and Spine Trauma, 11(2), 61–63.
[31]             Javdani Esfehani, K., Ghafoury, R., Hosseini, S. M., Hessam, R., Mohammadi, M., Hamidi, R., & Gholami Gharab, S. (2025). Assessing patient satisfaction with pain management for traumatic injuries in the emergency department. Rawal Medical Journal, 50(2), 501–505.
[32]             Asna Aashari, M., Aghazadeh, P., Javdani Esfehani, K., Hessam, R., Rezai, M., Tabibzadeh Dezfooli, S., & Javan, A. (2024). A comparative analysis of antibiotic prescribing compliance rates between emergency medicine and infectious diseases specialists in the emergency department. Avicenna Journal of Clinical Microbiology and Infection, 11(4), 177–181.
[33]             Mosaddegh, R., Mirzapoor, G., Mohammadi, M., …, Hessam, R., …, & Zarrin, A. (2024). Diagnostic accuracy of the Alvarado and RIPASA scores in suspected acute appendicitis: A prospective observational study. Journal of Payavand Medical Education.
[34]             Farsi, D., Zohri, D., Abbasi, S., Hessam, R., Navkhasi, S., & Saifpanahi, J. (2019). Comparison of the diagnostic values of four-point and two-point ultrasound versus CT scan in determining pneumothorax. Pajouhan Scientific Journal, 17(4), 9–14.
[35]             Moghadam,A M . (2026). Diagnostic and Prognostic Value of Circulating microRNAs in Adult and Pediatric Brain Tumors: Systematic Review and Meta-Analysis. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(3), 156-167.
[36]             Moghadam,A M . (2025). Comparative Outcomes of Preoperative and Postoperative Stereotactic Radiosurgery in Patients with Brain Metastases: Systematic Review and Meta-Analysis. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 1(11), 392-402.
[37]             Moghadam,A M . (2026). Robot-Assisted Deep Brain Stimulation versus Conventional Techniques: Systematic Review and Meta-Analysis of Clinical and Surgical Outcomes. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(2), 147-155.
[38]             Moghadam,A M . (2026). Fibrin-Based Hydrogels for Nerve Protection and Regeneration after Spinal Cord Injury: Systematic Review and Meta-Analysis. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(2), 106-116.
[39]             Mehrasa,P and Eghdam Zamiri,R. (2026). Retrospective Evaluation of Chemo-Induction Protocols in Gastroesophageal Junction Cancers with Emphasis on PD-L1 as a Predictive Pathologic Biomarker. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(4), 276-284.
[40]             Moghadam,A M . (2026). Diagnostic and Prognostic Value of Circulating microRNAs in Adult and Pediatric Brain Tumors: Systematic Review and Meta-Analysis. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(3), 156-167.
[41]             Moghadam,A M . (2025). Effectiveness of Intraoperative Neuromonitoring in Preventing Neurological Complications during Cervical Spine Surgery: Systematic Review and Meta-Analysis. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 1(11), 403-411.
[42]             Hosseini Kasnavieh SM, Milanifard M, Sedighi M, Hessam R. (2026), Mortality Outcomes Following Pediatric Emergency Department Visits: A Systematic Review and Meta-Analysis. Med J Islam Repub Iran. (13 Jun); 40:61.
[43]             Hosseini Kasnavieh SM, Milanifard M, Sedighi M, Hessam R. (2026), A Systematic Review of Pain Assessment Tools in Prehospital Emergency Care: Evidence from Observational Studies. Med J Islam Repub Iran. (10 Jun);40:60.
[44]             Hessam R, Basir Ghafouri H, Rezai M, Shaker S H, Hosseini Kasnavieh S M, Milanifard M et al . (2026), Hidden and Atypical Presentations of Myocarditis in Sudden Cardiac Death: A Narrative Review. Med J Islam Repub Iran; 40 (1) :526-536
[45]             Hessam R, Basir Ghafouri H, Rezai M, Shaker S H, Hosseini Kasnavieh S M, Milanifard M et al . (2026), Hidden and Atypical Presentations of Myocarditis in Sudden Cardiac Death: A Narrative Review. Med J Islam Repub Iran; 40 (1) :526-536
[46]             Sajed M, Alvandifar S, Mallahi M. (2024),  Evaluation of Root Canal Morphology of Mandibular Premolars Using Cone-beam Computed Tomography in Golestan Province, North of Iran. Iran Endod J. 2024;19(3):183-188.
[47]       Fakhari, S, Bilehjani, A and Bilehjani, E. (2026). Effect of Intraoperative Intravenous Dexmedetomidine on Oxidative Stress in Patients Undergoing Cardiac Surgery: A Systematic Review. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(5), 351-359.
[48]       Fakhari, S, Bilehjani, A and Bilehjani, E. (2026). Intravenous Dexmedetomidine in Cardiomyocyte Biology: A Systematic Review. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(5), 360-371.
[49]       Hussam Elddin Nabeih Khasawneh, AA., et al., (2025), A Novel Thiazole-Sulfonamide Hybrid Molecule as a promising Dual Tubulin/Carbonic Anhydrase IX Inhibitor with Anticancer Activity, Frontiers in Chemistry 13 (13), 13
[50]       Lotfi, A R and Nouri Bayat, L. (2026). Incidence of Postoperative Complications Following Nasal Fracture Surgery in Adults. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 2(2), 175-182.
[51]       Moghadam, A M. (2025). Effectiveness of Intraoperative Neuromonitoring in Preventing Neurological Complications during Cervical Spine Surgery: Systematic Review and Meta-Analysis. Medicinal, Psychological, and Health Research Journal (MPHRJ), 1(11), 378-386.
[52]       Moghadam, A M. (2025). Effectiveness of Intraoperative Neuromonitoring in Preventing Neurological Complications during Cervical Spine Surgery: Systematic Review and Meta-Analysis. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 1(11), 403-411.
[53]       Rezaei, M and Owaysee Osquee, H. (2026). Prevalence of Deep Vein Thrombosis in Patients with COVID 19 Admitted to the Intensive Care Unit. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(4), 267-275.
[54]       Sadeghzadeh, A. (2026). Evaluating the effectiveness and safety of hyaluronic acid versus poly-L-lactic acid for facial volume restoration: A Systematic Review and Meta-analysis. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 2(2), 102-113.
[55]       Samimi, A. Zarinabadi, S. (2011), Reduction of greenhouse gases emission and effect on environment, Aust. j. basic appl. sci., 5(12), 752-756
[56]       Samimi, A., Zarinabadi S., Shahbazi Kootenaei AH., Azimi A., Mirzaei M., (2019), Use of data mining in the corrosion classification of pipelines in catalytic reforming units (CRU), Eura. Chem. Commu., 1(6), 571–581
[57]       Samimi, A., Zarinabadi, S. (2012), Application solid polyurethane as coating in oil and gas pipelines, Chisa, 20th International Congress of Chemical and Process Engineering and 15th Conference Pres, 2012
[58]       Samimi,A. (2025). Investigating the Effect of Temperature and Pressure Changes in CCR Unit Reactors on Catalyst Wear and Black Dust Increase. Iranian Journal of Chemistry and Chemical Engineering, 44(12), 3039-3051.
[59]       Shiri, H and Ashrafi, N. (2026). Enhanced Recovery After Thoracotomy in the Intensive Care Unit: Current Evidence, Clinical Strategies, and Future Perspectives. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(5), 372-382.
[60]       Shiri, H and Ashrafi, N. (2026). Post Esophageal Surgery Dysphagia and Nutritional Support in the Intensive Care Unit. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(5), 339-350.
[61]       Zbuzant, M. (2026). Dental Implants vs. Traditional Bridges: A Comparative Clinical Review. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(3), 189-198.
[62]       Zbuzant, M. (2026). Minimally Invasive Techniques in Modern Restorative Dentistry. Medicinal, Psychological, and Health Research Journal (MPHRJ), 2(3), 177-188.
[63]       Hashemloo, A., Milanifard, M. (2025). Dermal Fillers: Types, Indications, and Complications Materials de Relleno: Typos, Indications Complications. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(6), 161-170
[64]       Hashemloo, A., Milanifard, M. (2025), Contouring Plus: A Comprehensive Approach of the Lower Third of the Face with Calcium Hydroxylapatite and Hyaluronic Acid, Medicinal, Psychological, and Health Research Journal, 1(5), 143-150
[65]       Sunder Raj, K. S. (2004). Multi-Pressure Surface Condenser Performance Evaluation: A Case Study. Proceedings of the ASME Power Conference.
[66]       Samimi,A. (2025). Investigating the Effect of Temperature and Pressure Changes in CCR Unit Reactors on Catalyst Wear and Black Dust Increase. Iranian Journal of Chemistry and Chemical Engineering, 44(12), 3039-3051.
[67]       Hedayati, A. Almasinia, B. Samimi, A. (2014),  Optimize pictures of industrial radiography in corrosion and sediment recognizing in oil or gas transmit pipe lines, International Journal of Chemistry, 5, 20-29
[68]       Samimi, A. Dokhani, S. Neshat, N. Almasinia, B. Setoudeh, M. (2012), The application and new mechanism of universal produce the 3-layer polyethylene coating, International Journal of Advanced Scientific and Technical Research, 465-473
[69]       Samimi, A. Samimi, M. (2020), Investigation of Risk Management in Food Industry, Int. J. Adv. Stu. Hum. Soc. Sci., 9 (3), 195-204
Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 2, Issue 5
September and October 2026
Pages 486-501

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