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Three Part Question

In [adult trauma patients presenting with hemorrhage or at high risk of hemorrhage], does [early treatment with IV tranexamic acid] [reduce rates of death and blood transfusion secondary to bleeding]?

Clinical Scenario

Adult trauma patient presenting with hemorrhage or at significant risk of hemorrhage. Can early administration of a 1 g loading dose of Tranexamic acid infused over 10 minutes followed by a transfusion of 1 g over 8 hours decrease rates of adverse events including further hemorrhage, blood transfusion and death?

Search Strategy

Ovid Medline search combining “Antifibrinolytic agents”, “Tranexamic acid”, and “Wounds and Injuries”.

Search Outcome

49 papers found, 1 of which was directly relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Crash-2 Collaborators June 15 2010 United Kingdom	Adult trauma patients with hemorrhage or at significant risk of hemorrhage	Randomized control trial (A level) with 20211 patients enrolled in 274 centres across 40 countries	Primary: Death in hospital within 4 weeks of injury	Allcause mortality significantly reduced in tranexamic acid group. (Relative risk 0.91, 95% CI 0.85-0.97; p=0.0035). Risk of death due to bleeding was significantly reduced (Relative risk 0.85, 95% CI 0.76-0.96; p=0.0077)

Comment(s)

A single randomized control trial has been carried out on tranexamic acid in trauma. However, this trial was impressively comprehensive and persuasive.

Clinical Bottom Line

1 g loading dose of tranexamic acid over 10 mins followed by a subsequent 1 g infused over 8 hours within 8 hours of injury significantly reduces mortality and rates of blood transfusion

References

1. Crash-2 Collaborators 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 The Lancet 2010 July 3, 376(9734) 23-32