Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial
The LancetPublished 15 June 2010Open access
J Williams-Johnson
Citations3,273
SJR quartileQ1
SJR score12.11
SNIP22.72
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study, and should be considered for use in bleed trauma patients.
Abstract
UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation.
Keywords
MedicineBiochemistry, Genetics and Molecular Biology
BMJMultiple imputation for missing data in epidemiological and clinical research: potential and pitfalls
7,164 Citations2009Jonathan A C Sterne, Ian R. White +6 more
The appropriate use and reporting of the multiple imputation approach to dealing with missing data is described by Jonathan Sterne and colleagues.
The LancetMaternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5
2,199 Citations2010Margaret C. Hogan, Kyle J Foreman +7 more
Although only 23 countries are on track to achieve a 75% decrease in MMR by 2015, countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress and substantial, albeit varied, progress has been made towards MDG 5.
Epidemiology of Trauma Deaths
1,857 Citations1995Angela Sauaia, Frederick A. Moore +5 more
There was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution in the Denver City and County trauma system, in comparison with the previous report.
The Journal of Trauma: Injury, Infection, and Critical CareImpact of Hemorrhage on Trauma Outcome: An Overview of Epidemiology, Clinical Presentations, and Therapeutic Considerations
1,462 Citations2006David S. Kauvar, Rolf Lefering +1 more
Improvements in early hemorrhage control and resuscitation and the prevention and aggressive treatment of coagulopathy appear to have the greatest potential to improve outcomes in severely injured trauma patients.
BMJPredicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients
1,213 Citations2008MRC CRASH Trial Collaborators
Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury and external validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination but poorer calibration.
Cochrane Database of Systematic ReviewsAnti-fibrinolytic use for minimising perioperative allogeneic blood transfusion
1,068 Citations2011David Henry, Paul A Carless +5 more
Data from the head-to-head trials suggest an advantage of aprotinin over the lysine analogues TXA and EACA in terms of reducing perioperative blood loss, but the differences were small.
The Journal of Trauma: Injury, Infection, and Critical CareAcute Coagulopathy of Trauma: Hypoperfusion Induces Systemic Anticoagulation and Hyperfibrinolysis
725 Citations2008Karim Brohi, Mitchell J. Cohen +5 more
Acute coagulopathy of trauma is associated with systemic hypoperfusion and is characterized by anticoagulation and hyperfibrinolysis, which correlates with thrombomodulin activity.
Trauma Mortality Patterns in Three Nations at Different Economic Levels
442 Citations1998Charles Mock, Gregory J. Jurkovich +3 more
The majority of deaths occur in the prehospital setting, indicating the importance of injury prevention in nations at all economic levels.
Bulletin of the World Health OrganizationInjuries: the neglected burden in developing countries
399 Citations2009Richard A. Gosselin
The importance of preventing and treating injuries in low- and middle-income countries has yet to be embraced by the global public health community, and research is grossly underfunded and insufficient resources have been allocated for strengthening the delivery of medical services.
Obstetric Anesthesia DigestMaternal Mortality for 181 Countries, 1980−2008
388 Citations2011M.C. Hogan, Kyle J Foreman +7 more
TrialsThe WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial
323 Citations2010Haleema Shakur‐Still, Diana Elbourne +5 more
The Trial aims to determine the effect of early administration of tranexamic acid on mortality, hysterectomy and other morbidities in women with clinically diagnosed postpartum haemorrhage in women with clinically diagnosed postpartum haemorrhage.
Cochrane Database of Systematic ReviewsAntifibrinolytic drugs for acute traumatic injury
320 Citations2015Katharine Ker, Ian Roberts +2 more
There is some evidence from pooling data from one study and a subset of data from CRASH-2 in patients with TBI which suggest that TXA may reduce mortality although the estimates are imprecise, the quality of evidence is low, and uncertainty remains.
AnesthesiologyThe Dose-Response Relationship of Tranexamic Acid
309 Citations1995Jan C. Horrow, Daniel F. Van Riper +3 more
Prophylactic tranexamic acid, 10 mg-kg -1 followed by 1 mg- kg -1 -h -1 , decreases bleeding after extracorporeal circulation and larger doses do not provide additional hemostatic benefit.
Journal of NeurotraumaPrognostic Value of Computerized Tomography Scan Characteristics in Traumatic Brain Injury: Results from The IMPACT Study
280 Citations2007Andrew I.R. Maas, Ewout W. Steyerberg +7 more
It is concluded that both the CT classification and individual CT characteristics are important predictors of outcome in TBI.
Cochrane Database of Systematic ReviewsAnti-fibrinolytic use for minimising perioperative allogeneic blood transfusion
252 Citations2007David Henry, Paul A Carless +6 more
The evidence reviewed here supports the use of aprotinin in cardiac surgery, and there was significant heterogeneity in trial outcomes, and some evidence of publication bias.
Anesthesia & AnalgesiaTranexamic Acid Reduces Blood Loss in Total Hip Replacement Surgery
180 Citations2000Gustav Ekbäck, Kjell Axelsson +6 more
It is found that preoperative administration of tranexamic acid, administrated before surgical incision, to be efficient in reducing bleeding during THR, probably by decreasing induced fibrinolysis.
Clinical TrialsSpecific barriers to the conduct of randomized trials
180 Citations2008Lelia Duley, Karen H. Antman +14 more
A radical re-evaluation of existing trial guidelines is needed, based on a clear understanding of the important principles of randomized trials, with the objective of eliminating unnecessary documentation and reporting without sacrificing validity or safety.
Anesthesia & AnalgesiaTranexamic Acid Reduces Blood Loss in Total Hip Replacement Surgery
176 Citations2000Gustav Ekbäck, Kjell Axelsson +6 more
BMC Emergency MedicineIntracranial bleeding in patients with traumatic brain injury: A prognostic study
168 Citations2009Pablo Perel, Ian Roberts +4 more
Anesthesia & AnalgesiaPlasma Tranexamic Acid Concentrations During Cardiopulmonary Bypass
163 Citations2001Bridget K. Fiechtner, Gregory A. Nuttall +7 more
Although tranexamic acid is used to reduce bleeding after cardiac surgery, there is large variation in the recommended dose, and few studies of plasma concentrations of the drug during cardiopulmonary bypass (CPB) have been performed.
BMC Pregnancy and ChildbirthAnti-fibrinolytic agents in post partum haemorrhage: a systematic review
119 Citations2009Pili Ferrer, Ian Roberts +3 more
Seminars in Thrombosis and HemostasisEnzyme-Controlling Medicines: Introduction
113 Citations1997Shosuke Okamoto, Akiko Hijikata‐Okunomiya +3 more
Seminars in HematologyChallenges for providing effective hemostasis in surgery and trauma
92 Citations2004Jeffrey H. Lawson, Michael P. Murphy
The initial treatment of patients with severe hemorrhage relies on improving the patient's physiological status and on basic surgical techniques, and a number of topical hemostatic agents, selective inhibitors of fibrinolysis, and procoagulant molecules may be utilized.
Thrombosis and HaemostasisSystematic Underestimation of Treatment Effects as a Result of Diagnostic Test Inaccuracy: Implications for the Interpretation and Design of Thromboprophylaxis Trials
72 Citations1995Anthony Rodgers, Stephen MacMahon
It is shown that, if there is no difference in the rate of misclassification of deep vein thrombosis between study and control groups, then treatment effects will tend to be systematically underestimated in trials that only use inaccurate diagnostic tests.
BMJThe time of death after trauma
54 Citations1995Janan Wyatt, D. Beard +3 more
The pre-eminence of trauma as a cause of death in young adults in the United Kingdom is well established, but little is known about the temporal distribution of these deaths.
Cochrane Database of Systematic ReviewsAntifibrinolytic drugs for acute traumatic injury
44 Citations2004Tim Coats, Ian Roberts +1 more
There is insufficient evidence from randomised controlled trials of antifibrinolytic agents in trauma to either support or refute a clinically important treatment effect.
BMC Medical Research MethodologyUse of the Oxford Handicap Scale at hospital discharge to predict Glasgow Outcome Scale at 6 months in patients with traumatic brain injury
26 Citations2008Pablo Perel, Phil Edwards +2 more
Oxford University Press eBooksLarge-scale randomized evidence: trials and meta-analyses of trials
20 Citations2010C. Baigent, R. Peto +3 more
This chapter takes a look at the use of large-scale randomized evidence—produced from trials and meta-analysis of trials—and how this data should be handled in order to produce accurate result.