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Tue Jun 15 19:59:51 BST 2010

Thank you. I apologise if my reference to the overall figures led to a
misunderstanding. As you say, the figures in this large high-quality trial
are persuasive.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Coats Tim - Professor of Emergency Medicine
Sent: 15 June 2010 12:40
To: Trauma-List [TRAUMA.ORG]
Subject: RE: A treatment you should use on your next bleeding trauma patient

Rowley,

I am very glad that you liked the presentations. Results were good, but
not quite as good as you quote. All cause mortality was 16% in the
control arm and 14.5% in the treatment arm. This gives a relative risk
of 0.91 (or a 9% reduction in the number of trauma deaths).

Most of this reduction in mortality was seen in the "cause of death
bleeding" group - with a relative risk of 0.85 of bleeding to death
after being given tranexamic acid (or a 15% reduction in death due to
bleeding in the treated group).

As you said, treatment with TXA did not give an increase in either
deaths associated with thrombosis or thromb-embolic events.

Tim.

Tim. Coats.
Professor of Emergency Medicine
University of Leicester, UK.
CRASH2 Trial Management Group 

-----Original Message-----
From: Blueflightmedic [mailto:trauma at emergencyunit.com] 
Sent: 14 June 2010 22:02
To: trauma-list at trauma.org
Subject: A treatment you should use on your next bleeding trauma patient

I was privileged today to be at the public release of the results of the
massive CRASH-2 trial of tranexamic acid in traumatic haemorrhage in
London.
It will be published in the Lancet, who have agreed to publish it freely
on
their website in full. Over 20,000 patients have been randomised in 274
hospitals in 40 countries. Here's the full trial protocol:
http://www.crash2.lshtm.ac.uk/ 

 It is not often one can say this, but the results are as stunning as
they
are unequivocal. Adding the administration of 1g of tranexamic acid over
10
minutes followed by an infusion of another 120mg per hour for 8 hours to
usual care leads to a 15% reduction in overall mortality at 4 weeks with
high levels of statistical significance, when compared with usual care.
The
most marked reduction was in bleeding-associated death. There were no
serious side effects and as an unexpected bonus there was a reduction in
subsequent pulmonary embolism. There was no increase in other vascular
events. The study was sponsored by the Health Technology Assessment,
part of
the UK Government National Institute for Health Research. Tranexamic
acid
has been available for about 40 years and costs around $8 a dose, so
treatment is cost-effective even in low GDP countries. It is a lysine
analogue that blocks fibrinolysis. The best effects were seen if
treatment
was started less than 3 hours after injury but a positive effect was
still
seen after that time.

Tranexamic acid is indicated after trauma where in the clinician's
opinion
there is likely to be significant haemorrhage. The actual entry criteria
were, "All trauma patients with ongoing significant haemorrhage
(systolic
blood pressure less than 90 mmHg and/or heart rate more than 110 beats
per
minute), or who are considered to be at risk of significant haemorrhage,
and
are within 8 hours of the injury, are eligible for trial entry if they
appear to be at least 16 years old. Although entry is allowed up to 8
hours
from injury, the earlier that patients can be treated the better." 

This is a really exciting advance in trauma care. The bottom line is
that
you should use it on the next trauma patient you see with bleeding.

Rowley.

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A treatment you should use on your next bleeding trauma patient