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 trial collaborators. Lancet 2010; 376: 23–32. doi: 10.1016/S0140-6736(10)60835-5

Clinical Question

• In trauma patients with or at risk of significant haemorrhage, does the early administration of a short course of tranexamic acid (TXA) affect the mortality, incidence of occlusive events and the amount of blood transfused?

N = 20207, 274 hospitals in 40 countries

Outcome

-  Primary outcome: death in hospital within 4 weeks of injury
-  Significant reduction in intervention group (14.5 vs 16%)
-  Secondary outcomes: no significant difference in intervention and control groups
-  Receipt of a blood-products transfusion
-  Surgical intervention
- Occurrence of vascular occlusive episodes (stroke, myocardial infarction, pulmonary embolism, clinical evidence of deep vein thrombosis)
- Unit of blood products transfused
- Dependency at hospital discharge or at day 28 if still in hospital

Authors’ Conclusions

-  TXA safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, TXA should be considered for use in bleeding trauma patients.

The Bottom Line

• The absolute risk reduction in mortality with the use of TXA in trauma patients is very small. Neither did it reduce the amount of blood products administered. However, TXA is unlikely to cause harm and hence will continue to be part of practice in the management of the bleeding trauma patient