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Winning hearts and minds
Tranexamic acid and life threatening bleeding
TXA reduces bleeding in surgery (Ker et al, 2012)
TXA
TXA better TXA worse
0.62 (0.58-0.65)
RR (95% CI)
0.4 0.8 1.2 1.6
Transfusion
TXA
RR (95% CI)
TXA better TXA worse
0 0.4 0.8 1.2 1.6
0.61 (0.38-0.98)
Mortality
TXA and bleeding
95 trials 72 trials
10,096 allocated TXA 10,115 allocated placebo
10,093 baseline data 10,114 baseline data
Followed up = 10,060 (99.7%)
Followed up = 10,067 (99.5%)
20,211 randomised
1 consent withdrawn
47 lost to follow-up
33 lost to follow-up
3 consent withdrawn
CRASH-2 trial profile
Any cause of death
TXA worseTXA better
0.8 0.9 1.0 1.1
RR (95% CI)TXA
(n= 10,060)
1,463 (14.5%)
Placebo
(n= 10,067)
1,613 (16.0%)
0.91 (0.85–0.97) 2P=0.0035
Death due to bleeding
TXA worseTXA better
0.8 0.9 1.0 1.1
RR (95% CI)TXA
(n= 10,060)
489 (4.9%)
Placebo
(n= 10,067)
574 (5.7%)
0.85 (0.76–0.96) 2P=0.0077
Effect of early TXA on death due to bleeding(by geographical region)
EU, Australia, Canada 48
Asia 114
Latin America 56
Africa 52
World
RR (95% CI) P=0.70
TXA worseTXA better
.6 .7 .8 .9 1 1.1.5
Hospitals
0.72 (0.63–0.83)
Fig 1 Deaths from all causes in patients with traumatic bleeding according to treatment with tranexamic acid (P=0.96 for heterogeneity).
Roberts I et al. BMJ 2012;345:bmj.e5839
©2012 by British Medical Journal Publishing Group
Fig 2 Death from bleeding in patients with traumatic bleeding according to treatment with tranexamic acid (P=0.98 for heterogeneity).
Roberts I et al. BMJ 2012;345:bmj.e5839
©2012 by British Medical Journal Publishing Group
Fig 4 Distribution of patients with traumatic bleeding in UK Trauma Audit and Research Network by baseline risk of death.
Roberts I et al. BMJ 2012;345:bmj.e5839
©2012 by British Medical Journal Publishing Group
Fig 5 Distribution of estimated premature deaths in patients with traumatic bleeding potentially averted with administration of tranexamic acid.
Roberts I et al. BMJ 2012;345:bmj.e5839
©2012 by British Medical Journal Publishing Group
2,161 reports
1,454 (68%) commentaries 555 (25%) case reports41 ( 2%) non-experimental60 ( 3%) randomized trials51 ( 2%) systematic reviews
Financial affiliation with manufacturer:
3 times more likely to recommend use
4 times more likely to downplay side effects
Novo-seven literature 2010
