Study: Tranexamic acid reduces bleeding deaths, thrombotic events in all trauma patients

Tranexamic acid can safely be used in all trauma patients, not just those who are the most severely injured, according to data analyses results published in the September 11 issue of the British Medical Journal.

In addition to the primary findings, researchers found that older trauma patients are likely to gain the most benefit from tranexamic acid because they have a higher baseline risk of death from hemorrhage and thrombotic events.

Ian Roberts, of the London School of Hygiene and Tropical Medicine, and colleagues reviewed data of 13,273 trauma patients in the CRASH-2 trial who were treated with tranexamic acid or placebo within 3 hours of injury, and patients who were enrolled in the UK Trauma and Audit Research Network between 2000 and 2008 with an estimated blood loss of least 20%. The patients were stratified by risk of death at baseline (<6%, 6-20%, 21-50%, >50%).

Researchers examined the effect of 1 g of tranexamic acid within 10 minutes, followed by 1 g over 8 hours, on all-cause mortality, deaths from bleeding, and thrombotic events. They also examined the combined and separate effect on arterial and venous thrombotic events.

In each stratum of baseline risk, the researchers found that fewer deaths occurred among patients treated with tranexamic acid. They estimated that the overall percentage of deaths that could be avoided by the administration of tranexamic acid in each stratum of baseline risk was 17%, 36%, 30%, and 17%, respectively.

There also was a significant reduction in the risk of fatal and non-fatal thrombotic events in patients treated with tranexamic acid (OR=0.69, 95% CI, 0.53-0.89; P=.005) as well as a significant reduction in arterial thrombotic events (OR=0.58, 0.40-0.83; P=.003). However, no significant reduction was seen in the risk of venous thrombotic events (OR=0.83, 0.59-1.17; P=.295). 

“Tranexamic acid reduced the odds of death from bleeding by about 30% in each of the baseline risk strata studied and reduced the odds of thrombotic events by about 30%,” the authors noted. They concluded that taken together, these data suggest that tranexamic acid can be administered safely to a wide spectrum of patients with traumatic bleeding and should not be restricted to the most severely injured.

This study was funded by the UK Health Technology Assessment program of the National Institute for Health Research.