Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.

Shakur H, Roberts R, Bautista R, et al.
Lancet 2010;376(9734):23-32.
NATA Rating :
Review by : J.-F. Hardy
NATA Review

This is a very important, landmark article describing for the first time the efficacy of an antifibrinolytic, tranexamic acid (TA), to decrease mortality in bleeding trauma patients. The study enrolled 20,211 adult trauma patients who were randomized to receive a short course of TA (2 g total) or placebo. The risk of death was decreased from 16% in the placebo group to 14.5% in the TA group (p = 0.0035) while vascular occlusive events were not increased by TA. The risk of death from bleeding was significantly reduced but, surprisingly, transfusions were not decreased by TA. Thus, further studies will be required to elucidate the mechanism of action of TA in this setting (see the accompanying editorial by Dr. Levy).

– Jean-Franois Hardy