Give Tranexamic Acid Early for Severe Hemorrhage from Trauma or Childbirth

Meta-analysis of two large trials suggests that effectiveness decreases 10% for every 15-minute delay and is negligible at 3 hours.

Tranexamic acid (TXA) has been shown to decrease deaths from acute severe bleeding. To determine if time to treatment is associated with the effectiveness of TXA, these authors conducted a systematic review and meta-analysis of randomized, placebo-controlled trials that included more than 1000 patients and examined any antifibrinolytic agent in the treatment of acute severe bleeding. Only two trials met the criteria, both of which used TXA: the CRASH-2 trial of patients with severe trauma and the WOMAN trial of women with severe hemorrhage in childbirth (NEJM JW Emerg Med Jul 2010 and Lancet 2010; 376:9734; NEJM JW Womens Health Jun 2017 and Lancet 2017;389:2105). Each trial provided patient-level data for roughly 20,000 patients.

Among the …

Reviewing Author

Daniel M. Lindberg, MD

Disclosures

RoyaltiesUpToDate

Grant/Research SupportEunice Kennedy Shriver National Institute of Child Health and Human Development; MINDSOURCE

Editorial BoardsThe Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal

Leadership Positions in Professional SocietiesThe Helfer Society (Executive Committee Member)