Tranexamic acid for trauma: filling the 'GAP' in evidence.
Following findings of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial, tranexamic acid (TxA) use post trauma is becoming widespread. However, issues of generalisability, applicability and predictability beyond the context of study sites remain unresolved. Internal and external validity of the CRASH-2 trial are currently lacking and therefore incorporation of TxA into routine trauma resuscitation guidelines appears premature. The Pre-hospital Antifibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH)-Trauma study is a National Health and Medical Research Council-funded randomised controlled trial of early administration of TxA in severely injured patients likely to have acute traumatic coagulopathy. The study population chosen has high mortality and morbidity and is potentially most likely to benefit from TxA's known mechanisms of action. This and further trials involving appropriate sample populations are required before evidence based guidelines on TxA use during trauma resuscitation can be developed.
National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Biswadev
B
Mitra
Stefan
S
Mazur
Peter A
PA
Cameron
Stephen
S
Bernard
Brian
B
Burns
Anthony
A
Smith
Stephen
S
Rashford
Mark
M
Fitzgerald
Karen
K
Smith
Russell L
RL
Gruen
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D009104:Multiple Trauma / Q000150:complications*; D012151:Resuscitation / Q000379:methods*; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
evidence-based practice; haemorrhage; resuscitation; tranexamic acid; wounds and injuries