Tranexamic Acid for Traumatic Hemorrhage: Best Given Within 1 Hour

Tranexamic acid given within 1 hour of injury reduced mortality by 32% compared with placebo.


In the CRASH-2 trial (JW Emerg Med Jun 15 2010), of 20,211 adult trauma patients with (or at risk for) hemorrhage who were randomized to receive tranexamic acid (TA) or placebo within 8 hours after injury, treatment with TA reduced all-cause in-hospital mortality without an increase in vascular occlusive events. In a follow-up analysis of CRASH-2 data, investigators evaluated the effect of TA on in-hospital mortality due to hemorrhage (35% of all deaths).

TA administration within 1 hour of injury significantly reduced mortality due to hemorrhage compared to placebo (5.3% vs. 7.7%; relative risk, 0.68) as did TA administration within 1 to 3 hours (4.8% vs. 6.1%; RR, 0.79). However, TA administration within 3 to 8 hours after injury significantly increased mortality due to hemorrhage (4.4% vs. 3.1%; RR, 1.44). The effect of TA did not vary by systolic blood pressure, Glasgow Coma Scale score, or type of trauma (blunt, penetrating, or both).


Citation(s):

The CRASH-2 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 Mar 26; 377:1096.