The CRASH-2 trial demonstrated that early administration of tranexamic acid (TXA) in trauma patients with significant haemorrhage reduces mortality. TXA should be administered within what time window from injury for maximum benefit?
- A Within 30 minutes
- B Within 1 hour (greatest benefit), up to 3 hours ✓
- C Within 6 hours
- D Within 12 hours
Correct answer: B. Within 1 hour (greatest benefit), up to 3 hours
Explanation
The CRASH-2 trial (20,000+ patients, 2010) showed TXA (loading dose 1g IV over 10 min, then 1g over 8 hours) significantly reduces all-cause mortality in trauma patients with or at risk of significant haemorrhage. The CRASH-2 subgroup analysis confirmed maximum mortality benefit within the first hour of injury, with diminishing benefit up to 3 hours. Critically, TXA administered >3 hours after injury was associated with increased mortality. This time-dependency is the key clinical point.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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