The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients

Abstract

Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Clinical Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 06/303/20. The contractual start date was in April 2007. The draft report began editorial review in January 2012 and was accepted for publication in August 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Background: Among trauma patients who survive to reach hospital, exsanguination is a common cause of death. A widely practicable treatment that reduces blood loss after trauma could prevent thousands of premature deaths each year. The CRASH-2 trial aimed to determine the effect of the early administration of tranexamic acid on death and transfusion requirement in bleeding trauma patients. In addition, the effort of tranexamic acid on the risk of vascular occlusive events was assessed.

The challenge in management of hemorrhagic shock in trauma

“…26 Tranexamic acid has been found to reduce the transfusion requirements and improve mortality in trauma patients. 16,27. The use of tranexamic acid with a loading dose of 1 g over 10 min followed by 1 g over 8 h is recommended (Grade 1A).…”

A Decade of Advances in Military Trauma Care

“…the 2010 clinical randomization of an Antifibrinolytic in Significant Hemorrhage 2 (crASH-2) trial, a prospective study of approximately 20,000 trauma patients, demonstrated a significant reduction in mortality rate among casualties who received txA compared to a control group who did not receive the drug. Early administration of the drug (<1 h from injury) was associated with the most significant reduction on mortality risk (12). the crASH-2 trial was the subject to some degree of criticism, mainly due the possible effect of undeveloped trauma systems, selection criteria, and different attributes of the trauma centers involved (13).…”

An international based survey on perioperative use of tranexamic acid in neurotrauma

“…The publication of the CRASH-2 trial opened a great interest in relation to the use of tranexamic acid and bleeding. (9). This has motivated the interest on the role of fibrinolysis in bleeding.…”