Effects of Tranexamic Acid on Bleeding Trauma Patients
“Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomised, placebo-controlled trial.” Lancet. 2010; 376: 23-32.
Hemorrhage is responsible for approximately one third of in-hospital trauma deaths. The study aimed to assess how administration of tranexamic acid (TXA) in trauma patients at risk of significant bleeding (HR >110, SBP <90) effected death, vascular occlusive events, and the receipt of blood transfusion.
Randomized controlled trial from 274 hospitals in 40 countries, including 20,211 adult trauma patients at risk of significant hemorrhage. Patients were randomly assigned within 8 hours of injury to a TXA group or a placebo group. TXA was administered as a 1 gram loading dose over 10 minutes, followed by an infusion of 1 gram over 8 hours. The primary outcome measured was death in the hospital within 4 weeks of injury. Cause of death was described by bleeding, vascular occlusion (i.e. MI, CVA, PE), multiorgan failure, and head injury. Secondary outcomes were vascular occlusive events (VOE), surgical intervention, receipt of blood transfusion, and units of blood transfused.
TXA significantly reduced all-cause mortality with no apparent increase in vascular occlusive events.
TXA safely reduces the risk of death in bleeding trauma patients and should be considered for use in this patient population.