title: Tranexamic acid in trauma: how should we use it?
abstract: Tranexamic acid (TXA) reduces blood loss by inhibiting the enzymatic breakdown of fibrin. It is often used in surgery to decrease bleeding and the need for blood transfusion. In 2011, results from a multi-center, randomized, and placebo-controlled trial (CRASH-2 trial) showed that TXA (1 g loading dose over 10 min followed by an infusion of 1 g over 8 h) safely reduces mortality in bleeding trauma patients. Initiation of TXA treatment within 3 h of injury reduces the risk of hemorrhage death by about one-third, regardless of baseline risk. Because it does not have any serious adverse effects, TXA can be administered to a wide spectrum of bleeding trauma patients. Limiting its use to the most severely injured or those with a diagnosis of 'hyperfibrinolysis' would result in thousands of avoidable deaths. A clinical trial (CRASH-3 trial) of TXA in patients with traumatic brain injury is now in progress.
authors.affiliation: Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Roberts
mesh_terms: D000818:Animals; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005342:Fibrinolysis / Q000187:drug effects*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: clinical trial; fibrinolysis; surgery; tranexamic acid; wounds and injuries