The CRASH-2 trial (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2) changed management of traumatic haemorrhage by demonstrating that tranexamic acid (TXA):

• A Significantly reduced 28-day mortality from haemorrhage when given within 3 hours of injury, with benefit diminishing after 3 hours ✓
• B Increased risk of thromboembolic events without mortality benefit when given after 3 hours of injury
• C Had no effect on haemorrhage-related mortality but reduced blood transfusion requirements
• D Was most effective when given >6 hours after traumatic injury

Explanation

The CRASH-2 trial (32,000 patients, 40 countries) demonstrated that tranexamic acid given within 3 hours of traumatic injury significantly reduced all-cause mortality and death from haemorrhage. Crucially, the analysis showed a clear time-dependent effect: TXA was most effective when given within 1 hour (significant mortality reduction) and also within 1–3 hours, but when given after 3 hours, there was a trend toward increased haemorrhage-related death (likely due to inhibition of fibrinolysis that had already occurred). This established TXA within 3 hours as standard protocol in all major trauma centres.

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

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Written and medically reviewed by the StethoPrep medical team.