CRASH-2 trial came out in 2010 to answer this question:
- What are the effects of the early administration of a short course of tranexamic acid on death in trauma patients with or at risk of significant haemorrhage?
CRASH-2 trial is a large placebo controlled trial undertaken in 276 hospitals in 40 countries.
- Patients were included if the doctors in charge were not sure whether to give TXA or not. Why? Probably because most of the patients included were not having massive hemorrhage (~70% had SBP>90, blunt type of injuries and GCS 13-15). So this is a study looking at TXA use in patients with mild-moderate hemorrhage.
- Death due to bleeding had ARR of 0.8% (4.9% in TXA vs 5.7% in placebo). NNT = 125
- No significant difference in the need for surgery and transfusion. TXA group received a mean of 6.06U of blood vs placebo with 6.3U of blood.
- Subgroup analysis showed greatest benefit of TXA in patients with SBP <75, RR=0·87 (CI 0·76–0·99).
- Subgroup analysis also showed some heterogeneity in TXA use >3 hours from injury. Subsequently, an exploratory analysis was carried out to evaluate mortality due to bleeding in different subgroups of patients.
– It showed that giving TXA >3 hours from injury lead to increased mortality from bleeding, RR=1.44, (CI 1.21-1.84)
- With NNT of 125, TXA does not seem to offer more than usually what we do in mild-moderate hemorrhage in term of mortality due to bleeding. In addition, there are no significant differences between need for surgery, transfusion and blood units.
- If you want to give, give it ASAP (within 1 hour of injury).
- TXA maybe more useful in more severe hemorrhage.
CRASH-2 trial collaborators. 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. Lancet 2010; 376: 23–32.
CRASH-2 trial collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 2011; 377: 1096–101.