Tranexamic acid - are you doin' it?

Todd Fraser on 25-02-2011

Major trauma is one of the most common admission diagnoses in intensive care practice. Early deaths from uncontrolled bleeding are a significant contributor to overall mortality. Tranexamic acid has been trialled in elective surgery and meta-analyses of these trials suggest a marked reduction in transfusion rates (mortality was not changed). So, could this be of benefit to trauma patients? A recent randomised controlled trial compared the use of Tranexamic acid with placebo in an attempt to reduce these bleeding events. It successfully did so, reducing deaths from bleeding from 5.7% to 4.9%. Overall 28 day mortality was also reduced from 16% to 14.5%. Surprisingly, not only were prothrombotic vascular complications (eg pulmonary embolus) not more frequently seen in the treatment group, deaths from such events were significantly reduced. Curiously, the authors state that patients entered into the trial were those for whom the treating doctor was "substantially uncertain" as to whether or not the patient would benefit from Tranexamic acid. It excluded those patients who had a "clear indication" for the drug. Despite this limitation, the study randomised a mind-boggling 20 000 patients! So is this enough to introduce it into your practice? Or do you have other strategies? (Read the article here : http://www.crit-iq.com.au/journals/abstract.cfm?journalId=353

2 Comments

Got something to say?

Log in to your account

Forgotten your password?

Alex McKenzie wrote 08-29-2011 05:22:17 pm
Forgive me, but isn't biological plausibility important in the interpretation of a paper?

There was no decrease in blood transfusions in this paper - so how does it work?

Todd Fraser wrote 04-26-2011 06:03:47 pm
A follow up paper has just been released - the authors of CRASH 2 found that Tranexamic Acid worked better if you used it earlier. (Is this just a way of wringing as many papers out of a study as possible?)