An hour can make the difference between life and death when using tranexamic acid to treat injured patients with severe bleeding. This is the conclusion of an Article published Online First and in an upcoming Lancet, written by Professor Ian Roberts, London School of Hygiene and Tropical Medicine, UK and colleagues from the CRASH-2 Collaboration.
The CRASH-2 trial was published in June 2010 in The Lancet, and found that administration of tranexamic acid to adult trauma patients who were bleeding (or at high risk of bleeding) reduced mortality by around 10%. As a consequence of this trial, tranexamic acid has been incorporated into trauma treatment protocols worldwide.
In this new analysis, the authors looked at subgroups of patients who had received tranexamic acid less than one hour post-injury; between one and three hours; or more than three hours.
Early treatment (within an hour of injury) reduced the risk of death due to bleeding by more than 30% compared with placebo. Treatment given between one and three hours cut the risk of bleeding to death by 20% compared with placebo, but there was no benefit, and possible harm, if treatment was delayed beyond 3 or 4 hours.
Professor Roberts says*: "In patients with severe bleeding whether from accidents or violence, rapid treatment with tranexamic acid is vital—an hour could mean a lifetime."
He adds: "The discovery has already led to the British military using the therapy in the first hour to treat wounded soldiers in Afghanistan; and, to ensure that civilian trauma patients benefit from crucial early treatment, the NHS may need to consider giving tranexamic acid in ambulances."
In a Comment, Russell Gruen from Monash University, Melbourne, Australia says: "The best place for tranexamic acid in developed trauma systems might actually be in the pre-hospital environment. Helicopter and road transport direct to major trauma centres has reduced overall injury mortality, but has extended the time before patients reach hospital…In view of the findings from CRASH-2, the best outcomes might be achieved with simple measures for haemorrhage control and early inhibition of coagulopathy with tranexamic acid, followed by rapid transport for surgery or angiography and tailored management of coagulopathy in hospital."
Professor Ian Roberts, London School of Hygiene and Tropical Medicine, UK. Via Paula Fentiman, Press office, London School of Hygiene and Tropical Medicine T) +44 (0)207 927 2802 E) paula.fentiman@lshtm.ac.uk
Professor Russell Gruen, Monash University, Melbourne, Australia. T) +61 3 9076 2561 E) r.gruen@alfred.org.au
For link to CRASH-2 website, which will go live at the time the embargo lifts, see: http://www.thelancet.com/crash-2
Notes to Editors: *Quotes direct from Professor Ian Roberts and cannot be found in the text of the Article.
NOTE: IF YOU WISH TO PROVIDE A LINK TO THE FREE ABSTRACT OF THIS PAPER FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60278-X/abstract
Journal
The Lancet