Crash 2 and Tranexamic Acid
One of the most exciting and underutilized therapies for trauma is tranexamic acid (txa). TXA inhibits the breakdown of clot–it is an anti-fibrinolytic. Is there evidence for using this in trauma patients?
First came the Crash 2 Trial (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. Lancet 2010; 376: 23–32),
then the subgroup reanalysis (Lancet. 2011 Mar 26;377(9771):1096) showing the benefit of treatment as early as possible.
Recently, the MATTERS trial (Arch Surg. 2012; 147:113-119) was published demonstrating the benefits of TXA in military situations, particularly massive transfusion.
How about an incredible review from the J Trauma (2011; 71(1) Supplement S9)
Then there is this paper describing current military protocol rationale.
To discuss TXA in Trauma, I got to interview Dr. Tim Coats, one of the primary authors of Crash 2.
Here is a List of Resources from the Crash 2 Investigators
This is the official resource page from Crash 2
We also discussed the concept of the pragmatic trial…
Future Research in Emergency Medicine: Explanation or Pragmatism
Listen to the podcast excerpt on pragmatic trials (mp3–right click the link and choose save-as if you want to download)
In an amazing demonstration of synchronicity, Jeff Guy of the ICU Rounds Podcast put out a tranexamic acid episode on the same day.
Minh Le Cong provided this prehospital protocol for TXA use.
An incredible review article can be found at this citation (Journal of TRAUMA 2011;71(1) July Supplement)