The CRASH-2 study, published in 2010, showed that treatment with tranexamic acid resulted in a reduction of mortality in trauma patients with significant hemorrhage. Now the authors present a prespecified analysis on the effect of tranexamic acid in patients with various baseline risks of death. Patients were assigned to four strata (risk of death at beasline <6%, 6-20%, 21-50%, and >50%, respectively), based on a prognostic model that was developed to predict all-cause mortality in patients with life-threatening traumatic bleeding, derived from the same CRASH-2 study. They demonstrated that the beneficial effect of tranexamic acid on mortality was present in each stratum, although the relative effect was most prominent in the higher risk groups.

The importance of this study is that it shows that tranexamic acid is not only effective in the most severely injured patients but has a positive effect in all severity groups. As the analysis also shows that tranexamic acid is safe in all injury severity groups, the authors’ conclusion that this drug should be administered to a wide spectrum of bleeding trauma patients seems justified.

– Marcel Levi