Simple injection could save thousands of lives

Tens of thousands of lives could be saved each year if patients with serious bleeding received a cheap, widely available and easily-administered drug to help their blood to clot, according to researchers from the University of Sydney.

The results of the international CRASH-2 trial showed that early administration of tranexamic acid (TXA) to patients with recent, severe bleeding injuries saved lives, with no evidence of adverse effects from unwanted clotting.

The trial results are published online recently by the international medical journal, The Lancet.

Dr Ian Seppelt from Sydney Medical School was the national coordinator for Australian participation in the research.

Dr Seppelt said the CRASH-2 trial involved more than 20,000 adult patients in 274 hospitals across 40 countries.

"It is the first trial of TXA in injured patients, although smaller trials have shown that it reduces bleeding in surgical patients," he said.

"The drug helps by reducing clot breakdown. Although this would be advantageous in patients with severe bleeding, doctors were worried that TXA might increase the risk of complications, such as heart attacks, strokes and clots in the lungs.

"But the results of this trial show that TXA reduces death from bleeding without any increase in these complications."

Dr Seppelt said that administering TXA soon after injury could prevent up to 100,000 deaths per year across the world.

"In Australia this treatment could prevent over a hundred deaths each year."

Dr Seppelt said currently only oral TXA is available in Australia, not the intravenous form.

"The lack of intravenous tranexamic acid in Australia needs to be urgently rectified," he said.

Severely injured adults were enrolled in the trial if they had significant bleeding, or were at risk of significant bleeding and were within a few hours of injury. They were randomly allocated to receive either one gram of TXA by injection, followed by another one gram in a drip over the following eight hours, or a matching placebo.

The researchers studied the numbers of deaths in hospital within four weeks of injury in the two groups and found that TXA reduced the chances of death due to massive blood loss by about one-sixth.

(Source: University of Sydney: Lancet: June 2010)