The CRASH-2 trial showed us that Tranexamic acid (TXA) reduces mortality in trauma if given within 8 hours of injury. A new BMJ meta-analysis examined the effect of the drug on surgical bleeding. It failed to show a statistically significant reduction in mortality (though the RR was 0.67), but did result in less blood transfusion (RR 0.62, p<0.001), with no significant adverse effects. Interestingly, the RR for MI was 0.68 (less bleeding, better perfused coronaries), for stroke 1.14, (nether significant, take your pick!).
It makes you wonder why TXA is so underused. It costs $100 per gram, with the unlicensed Factor 7 costing a whopping $1,200,000 per gram, with no evidence of benefit and a strong suggestion of harm. Again, take your pick.
The National Blood Authority‘s excellent Patient Blood Management Guidelines are in production. The Critical Bleeding Massive Transfusion guideline is complete, and recommends tranexamic acid in trauma patients. The Perioperative guideline recommends tranexamic acid for the prevention of major blood loss in cardiac and non-cardiac surgery where there is a high risk of bleeding. Neither guideline recommends the routine use of Factor 7, and both point out that its emergency use, when all else has failed, has no evidence of benefit, and is unlicensed.
We think the NBA guidelines are so good, we’ve given them their own page – under Resources. Enjoy.