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