Tranexamic acid and pre-hospital trauma setting: Is everything clear by now?

Abstract An early use of tranexamic acid (TXA) in polytrauma patients has long been emphasized, although several conflicting evidence make its applicability still controversial and claims debate. Several multicenter trials have been conducted and the latter appear to collide with recent evidence published in the literature. In particular, the putative effects of early prognostic and hospitalization are still far from a common recommendation. We believe conflicting evidence derives from an unproper standardization of the pre-hospital setting, where non-diversified demographic factors, such as sociodemographic ones and accessibility to resources, still play a significant and detrimental role in patients’ outcomes. Moreover, evaluation and investigation of the real benefits of TXA administration in the trauma patient according to the different settings or scenarios are required, as the availability of resources could represent a non-negligible bias that could lead to evidence too far from universal applicability and accessibility.