Another win for tranexamic acid in trauma related bleeding

New trial results out this week show that the antifibrinolytic tranexamic acid significantly reduces the risk of death due to bleeding, regardless of the cause, an international expert says.

Speaking during the opening presidential session of Blood 2019, UK haematologist Professor Beverley Hunt said that while haemorrhage was the major cause of death in trauma it was easily preventable.

Blood transfusions and the use of blood components were key in managing trauma-related bleeding but tranexamic acid (TXA) was effective in this setting, and was readily available and cost-effective.

“It’s a drug that has been around since the 1950s and it is very simple… it is an analogue of the amino acid lysine which binds to plasminogen at its lysin binding site inhibiting the breakdown of fibrin blood clots,” Prof. Hunt told the conference.

Results from the global trauma trial CRASH-2, published in 2010, showed that giving TXA within the hour of the trauma patient arriving at the emergency department reduced 128,000 deaths globally each year. And even giving it within three hours saved 112,000 lives.

“It showed that TXA reduced mortality for the first time, and the only time a pharmaceutical agent has been shown to reduce death due to bleeding,” said Prof. Hunt, a professor of thrombosis and haemostasis at King’s College, London.

One key thing about TXA was that no increased risk of thrombotic events was observed in CRASH-2 or in any other RCT using TXA, Professor Hunt noted.

She said that CRASH-3, published in The Lancet this week looked at TXA in patients with TBI and found it reduced head injury-related death by 20 per cent.

“There are some criticisms of the study because they did change the design halfway through which you’re not meant to do but this is a pragmatic trial,” Prof. Hunt noted.

In Europe, TXA is used pre-hospital in paramedic packs, trauma helicopters and by the military.

“NHS England has introduced a tariff so if you don’t give TXA to someone who is bleeding you pay a financial forfeit… which is always a good way to get doctors to do things,” she said.

“It’s become a WHO essential drug, it’s $5 a gram so it’s very beneficial, we need to get it out to third world countries, the problem being that many still can’t afford it.”

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