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1 consent withdrawn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3 consent withdrawn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