Prescrire international
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Prescrire international · Jul 2013
ReviewTrauma and severe bleeding. Tranexamic acid within one hour to reduce mortality.
Tranexamic acid, an antifibrinolytic agent, reduces postoperative transfusion requirements but carries a poorly documented risk of thrombosis. Does tranexamic acid reduce mortality among victims of severe traumatic bleeding? To answer this question, we conducted a review of the literature, using the standard Prescrire methodology. The Crash-2 trial compared the impact of tranexamic acid versus placebo on overall mortality in 20 211 trauma victims with either severe bleeding or a high risk of severe bleeding. ⋯ Cases of thrombosis have also been reported. In 2011, the FDA warned of a risk of convulsions linked to high intravenous doses of this drug. In practice, intravenous tranexamic acid infusion has a favourable harm-benefit balance in patients with severe traumatic bleeding, especially when treatment begins less than 1 hour after injury, in which case it reduces mortality at 4 weeks.