Tranexamic acid in trauma
Date First Published:
October 14, 2010
Last Updated:
May 10, 2011
Report by:
Kyle McCoy, Medical Student (University of Calgary)
Search checked by:
Eddy Lang, University of Calgary
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”.
Outcome:
49 papers found, 1 of which was directly relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| 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 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) |
Author Commentary:
A single randomized control trial has been carried out on tranexamic acid in trauma. However, this trial was impressively comprehensive and persuasive.
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:
- 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