The use of tranexamic acid during surgeries is associated with less blood losses and less needs of transfusions. According to this statement, with a randomized trial, partly sponsored by pharmaceutical industry (CRASH-2: Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2) the efficacy of this antifibrinolytic has been assessed in 20,211 patients experimenting injuries and bleeding risk. The drug (or placebo) has been given within the first 8 hours after injury; the dose of tranexamic acid has been 1 g within the first 10 minutes, followed by a slow infusion of 1 g during the following 8 hours. The mortality rate for any cause within 4 weeks after injury resulted significantly lower in the group treated with tranexamic acid (14.5% vs. 16.0%; RR 0.85), as well as the number of deaths for bleedings has been reduced (4.9% vs. 5.7%; RR 0.85). About half of the patients in both groups have been treated with blood or hemoderivative transfusions. The incidence of vascular occlusive events (infarctions, strokes, pulmonary embolisms, DVTs) was similar in the two groups (about 2%). There has been no severe side effect in the drug group.
Tranexamic acid costs a little, it has an easy way of administration, it has no severe side effects and it reduces mortality after severe injuries: according to this trial (which is methodologically well performed), the treatment protocol of severe injuries should include the use of this antifibrinolytic.
