Worldwide, traumatic injury is responsible for over 5 million deaths per year, the majority due to exsanguination and head injury. The antifibrinolytic drug tranexamic acid is the only drug proven to reduce deaths after traumatic injury. Several large randomized controlled trials have provided high-quality evidence of its effectiveness and safety in trauma patients. Early tranexamic acid reduces deaths on the day of the injury in polytrauma patients and patients with isolated traumatic brain injury by around 20%. Treatment is time critical; for patients to benefit, tranexamic acid must be given as soon as possible after injury. Intramuscular administration is well tolerated and rapidly absorbed, with the potential to reduce time to treatment. Because the proportional reduction in bleeding death with tranexamic acid does not vary by baseline risk, a wide range of trauma patients stands to benefit. There are far more low-risk trauma patients than high-risk patients, with a substantial proportion of bleeding deaths in the low-risk group. As such, treatment should not be limited to patients with severe traumatic hemorrhage. We must give paramedics and physicians the confidence to treat a far wider range of trauma patients while emphasizing the importance of early treatment.

在世界范围内，每年有超过 500 万人死于外伤，其中大部分是由于失血和头部受伤造成的。抗纤溶药物氨甲环酸是唯一被证明可以减少外伤后死亡的药物。几项大型随机对照试验为其在创伤患者中的有效性和安全性提供了高质量的证据。早期氨甲环酸可使多发伤患者和孤立性脑外伤患者在受伤当天的死亡人数减少约 20%。治疗时间紧迫；为了使患者受益，必须在受伤后尽快给予氨甲环酸。肌内给药耐受性良好且吸收迅速，有可能缩短治疗时间。因为使用氨甲环酸减少出血死亡的比例不会因基线风险而异，范围广泛的创伤患者将受益。低危创伤患者远多于高危患者，低危组的出血死亡人数占很大比例。因此，治疗不应仅限于严重外伤性出血的患者。我们必须让护理人员和医生有信心治疗更广泛的创伤患者，同时强调早期治疗的重要性。