TXA is a safe, inexpensive medication that prevents fibrin breakdown. In traumatic bleeding, it conveys a significant mortality benefit with an impressive NNT for mortality between 7 and 67, depending on injury severity, without apparent serious safety issues. This benefit is associated with early administration. TXA should not be given more than three hours after injury as it may increase mortality after this timeframe. It appears to have equal benefit in a variety of trauma practice environments.
Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008).
Tranexamic acid (1g given over 10 min (IVI) followed by 1g given over 8h (IVI)) can save 1 in 67 patients with severe trauma
CRASH-2: A large multicenter randomised control trial of 20,211 patients (CRASH2) found:
The most severely injured patients who received TXA had the highest reduction in mortality. Benefits were greatest for those treated within 3 hours of injury and subgroup analysis demonstrated that TXA was most effective in patients with shock (systolic blood pressure < 75 mmHg).