Crash-2

By Nelson Wong, MD

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial

Lancet 2010;376:23-32

Background

Trauma is a major cause of death worldwide.  Lethal triad of trauma and hemorrhage includes coagulopathy, acidosis and hypothermia.  TXA, an antifibrinolytic, clot stabilizing medication, has been shown to decreased the need for transfusion in surgery.

 

Methods:

Randomized placebo-controlled trial

40 Countries, 274 Hospitals

20,211 patients

Analyzed with intention to treat

 

Inclusion:

Adults with or at risk for hemorrhage (SBP<90, HR>110)

Physican thought there was clinical equipoise

Within 8 hours of injury

 

Intervention

1g TXA in 10 min, then 1g TXA in next 8 hours

 

Primary Endpoint

Death within 4 weeks – divided into bleeding, vascular occlusion (MI, stroke, PE), multiorgan, head injury or other.

 

Secondary Endpoint

Vascular occlusions

Surgical intervention

Blood transfusions

 

Results

1.5% absolute all cause mortality decrease, NNT ~67

No Difference in the rate of PE/DVT or transfusion requirements

Post-Test Here

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