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
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.
Randomized placebo-controlled trial
40 Countries, 274 Hospitals
Analyzed with intention to treat
Adults with or at risk for hemorrhage (SBP<90, HR>110)
Physican thought there was clinical equipoise
Within 8 hours of injury
1g TXA in 10 min, then 1g TXA in next 8 hours
Death within 4 weeks – divided into bleeding, vascular occlusion (MI, stroke, PE), multiorgan, head injury or other.
1.5% absolute all cause mortality decrease, NNT ~67
No Difference in the rate of PE/DVT or transfusion requirements