The CRASH-2 trial evaluated tranexamic acid (TXA) in major trauma with haemorrhage. Its key finding regarding the timing of TXA administration was:

• A TXA should only be given within 1 hour of injury for any benefit
• B TXA benefit is independent of time from injury up to 8 hours
• C TXA reduces mortality only when combined with FFP in a 1:1 ratio
• D TXA must be given within 3 hours of injury; administration after 3 hours is harmful (increases mortality) ✓

Explanation

The CRASH-2 trial (>20,000 patients) showed that TXA (1 g IV over 10 min, then 1 g over 8 hours) reduced all-cause mortality when given within 3 hours of injury. Crucially, a sub-analysis showed that TXA given after 3 hours from injury was associated with increased mortality from haemorrhage, making the 3-hour window a critical treatment parameter. Based on this, TXA should be administered as early as possible and always within 3 hours of injury. It is now included in WHO essential medicines and ATLS recommendations.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.