Tranexamic acid for trauma

Abstract

After its publication in July, 2010, the CRASH-2 study 1 CRASH-2 trial collaboratorsEffects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23-32 Summary Full Text Full Text PDF PubMed Scopus (2053) Google Scholar generated widespread interest in the early administration of the antifibrinolytic agent tranexamic acid to patients with traumatic bleeding. Tranexamic acid is an inexpensive, easily used, and relatively safe drug, and it seemed to have saved lives. However, how it did so was unclear—the blood-transfusion requirements of the tranexamic acid and placebo groups were similar and, survival bias notwithstanding, the mortality benefit might have been attributable to an effect of tranexamic acid on something other than acute traumatic coagulopathy. 2 Levy J Antifibrinolytic therapy: new data and new concepts. Lancet. 2010; 376: 3-4 Summary Full Text Full Text PDF PubMed Scopus (86) Google Scholar Effect of consent rituals on mortality in emergency care researchClinical trials are important in improving the safety and effectiveness of emergency care. Many such trials seek to assess the effects of time-critical treatments for life-threatening disorders such as traumatic brain injury, severe haemorrhage, or respiratory distress. In general, before patients can be enrolled in such trials, current regulations require that they or their legal representatives provide written informed consent.1,2 Although the requirement for written informed consent can sometimes be waived3—eg, if the patient is unconscious, treatment is urgent, and no relative is available—written consent is usually required in emergency-care research, despite the delays to treatment that this will usually entail. Full-Text PDF The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trialTranexamic acid should be given as early as possible to bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful. Full-Text PDF