UMEM Educational Pearls

Tranexamic acid (TXA) is an antifibrinolytic that prevents clot breakdown by inhibiting plasminogen activation and plasmin activity

The CRASH-2 trial enrolled 20,211 adult trauma patients with significant hemorrhage (SBP <90 or HR 110) or at significant risk of hemorrhage

Patients were randomized to 1 gram TXA over 10 minutes followed by an infusion of 1 gm over 8 hours vs placebo

There was a significant reduction in the relative risk off all cause mortality of 9% (14.5% vs 16%, RR 0.91, CI 0.85-0.97, p = 0.0035)

The patients that benefited most were those most severely injured, and in those treated in less than 3 hours of injury.


1. 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 randomized, placebo controlled trial. The Lancet. 2010; 376:23-32.

2. Cap AP, Baer DG, Orman JA, Aden J, Ryan K, Blackbourne LH, Ryan K. Tranexemic Acid for Trauma Patients: A Critical Review of the Literature. Journal of Trauma, Injury, Infection and Critical Care. July 2011 Vol 71(1):S9-S14.