The effect of the early administration of tranexamic acid (TXA)
Among trauma patients who survive to reach hospital, exsanguination is a common cause of
death. A widely practicable treatment that reduces blood loss after trauma could prevent thousands of
premature deaths each year. The CRASH-2 trial aimed to determine the effect of the early
administration of tranexamic acid on death and transfusion requirement in bleeding trauma patients. In
addition, the effort of tranexamic acid on the risk of vascular occlusive events was assessed.
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. The primary
outcome was death in hospital within 4 weeks of injury, and was described with the following
categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism),
multiorgan failure, head injury, and other AL analyses were by intention to treat.
10096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10060 and
10067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid
(1463 [14.5%] tranexamic acid group vs 1613 [160%] placebo group; relative risk 0.91, 95% CI 085-097; p
= 00035). The risk of death due to bleeding was significantly reduced (489 [49%] vs 574 [5-7%]; relative
risk 0-85, 95% CI 0.76-0.96; p = 0-0077).
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. Future
work [the Clinical Randomisation of an Antifibrinolytic in Significant Head injury-3 (CRASH-3) trial] will
evaluate the effectiveness and safety of TXA in the treatments of isolated traumatic brain injury
The PATCH-Trauma Study is an international multi-centre, randomised, double-blind, placebocontrolled trial of pre-hospital treatment with tranexamic acid for severely injured patients at risk of
acute traumatic coagulopathy. The study aims to determine the effects of early administration of
tranexamic acid on survival and recovery of severely injured patients treated within advanced trauma
International multi-centre, double-blind, randomised, placebo-controlled trial
1200 participants at high risk of acute traumatic coagulopathy
Pre-hospital treatment with tranexamic acid in advanced trauma systems
Mortality and functional recovery at six months
Assessment of fibrinolysis, coagulation, and thrombotic events
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