CRASH-2 study證明transamine打的有道理，不過減少因為bleeding造成的risk 實在不多

Tranexamic Acid Reduces Mortality After Major Trauma

This promising new therapy is inexpensive and easy to administer.

The antifibrinolytic agent tranexamic acid has been shown to decrease blood loss and transfusion requirements during surgery. In the randomized, controlled, partly industry-funded international CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2) trial, researchers evaluated the effect of tranexamic acid on outcomes in 20,211 adult trauma patients with (or at risk for) bleeding. Tranexamic acid (loading dose of 1 g during 10 minutes followed by infusion of 1 g during 8 hours) or placebo was administered within 8 hours of injury.

The rate of in-hospital mortality from all causes within 4 weeks of injury was significantly lower in the tranexamic acid group than in the placebo group (14.5% vs. 16.0%; relative risk, 0.91). Risk for hemorrhagic death was also reduced (4.9% vs. 5.7%; RR, 0.85). About half the patients in each group received blood product transfusions. The incidence of vascular occlusive events (myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis) was similar in the two groups (about 2%). No unexpected or serious adverse events attributed to the study drug occurred.

Comment: Tranexamic acid is inexpensive, is simple to administer, and has the potential to reduce mortality from hemorrhage following traumatic injury. On the basis of the results of this large, well-designed, international study, centers caring for trauma patients should review their protocols and consider adding tranexamic acid for patients with active hemorrhage or significant risk for recurrent or ongoing bleeding.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine June 15, 2010

Citation(s):

CRASH-2 trial collaborators. 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 Jun 15; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S0140-6736(10)60835-5)

Levy JH. Antifibrinolytic therapy: New data and new concepts. Lancet 2010 Jun 15; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S0140-6736(10)60939-7)


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