In reply: We agree with Jarman and Brier that there is safety evidence for tranexamic acid (TxA) in elective surgery. We hypothesise that TxA’s effects in trauma are different. At least 1.5%–2% of trauma patients develop deep vein thrombosis (DVT) and pulmonary embolism (PE), and those who do average twice as long in hospital, are twice as likely to die, and face the long-term risks of anticoagulation and vena-caval filters.1,2 TxA impairs clot breakdown, so could cause excess PEs and DVTs in this higher-risk population, as seen in the MATTERs study.
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