Tranexamic acid reduces risk of death in bleeding trauma patients

January 01, 0001

Tranexamic acid reduces risk of death in bleeding trauma patients

Tranexamic acid can reduce bleeding in patients undergoing elective surgery. The researchers assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20,211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were masked to treatment allocation. 10,096 patients were allocated to tranexamic acid and 10,115 to placebo, of whom 10,060 and 10,067, respectively, were analysed.

All-cause mortality was significantly reduced with tranexamic acid (14.5% tranexamic acid group vs 16.0% placebo group; relative risk 0.91). The risk of death due to bleeding was significantly reduced (4.9% vs 5.7%; relative risk 0.85).

The researchers concluded: "Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients."

Although probably only relevant to GPs involved with trauma management, this is worth knowing and following by all.

For the full abstract, click here.

The Lancet published online 15 June 2010
© Elsevier Ltd 2010
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. CRASH-2 trial collaborators.

Category: B. Blood/Blood Forming Organs/Immune Mechanisms. Keywords: tranexamic acid, effects, death, vascular occlusive effects, blood transfusion, trauma, hemorrhage, randomised, placebo-controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 2 July 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.