The CRASH-2 trial was published in the Lancet in June 2010, and presents strong evidence for the use of tranexamic to reduce haemorrhage in the context of major trauma. The fact that tranexamic is cheap, seems to be safe, and is easy to obtain & administer makes it an attractive drug for general use. The study used a 1g IV bolus over 10 minutes (within 8 hours of injury), followed by 1g IV infusion over eight hours.
It would seem that tranexamic acid may have the particular potential to benefit patients who have suffered major trauma in rural areas, where the logistics of transfer/retrieval can result in prolonged time to definitive surgical care. Permissive hypotension is standard practice, with a similar rationale to avoid destabilising clot formation that has already occurred. The question now is whether it can be used routinely in rural community hospitals, or even by emergency responders such as BASICS GPs, or is there a need to wait until more specific guidance? In a bid to gauge its current use, a discussion has been start on the RuralGPNetwork, and any relevant updates will be posted here. In the meantime comments are welcomed below too.
- The original article (PDF; The Lancet). CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with signiﬁ cant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; published online June 15. DOI:10.1016/S0140-6736(10)60835-5.
- The associated editorial (PDF; The Lancet) by J Levy.
Dr Levy has also issued a YouTube video on this paper:
… and The Lancet has recorded its press conference when the paper was published: you can listen to it here.