Tranexamic acid (TXA) is administered in a trauma patient with suspected major haemorrhage. According to the CRASH-2 trial, the optimal timing of administration is:
- A Within 6 hours of injury; no time restriction
- B Immediately before surgery regardless of time since injury
- C Within 1 hour of injury for maximum benefit; some benefit up to 3 hours ✓
- D After clinical coagulopathy is confirmed on laboratory tests
Correct answer: C. Within 1 hour of injury for maximum benefit; some benefit up to 3 hours
Explanation
The CRASH-2 trial showed that TXA given within 1 hour of injury significantly reduced mortality (RR 0.68); benefit was also present when given 1–3 hours post-injury (RR 0.79), but administration after 3 hours was associated with increased mortality (RR 1.44), possibly due to a pro-thrombotic effect after fibrinolysis has resolved. Therefore, TXA must be given as early as possible and ideally within 3 hours; it should NOT be given after 3 hours. The drug acts by inhibiting plasminogen activation (anti-fibrinolytic).
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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