The CRASH-2 trial established the benefit of tranexamic acid (TXA) in trauma. What is the critical time window beyond which TXA is not recommended and may increase mortality?

• A Beyond 1 hour from injury
• B Beyond 6 hours from injury
• C Beyond 3 hours from injury ✓
• D Beyond 12 hours from injury

Explanation

The CRASH-2 trial showed that TXA reduces all-cause mortality and death from bleeding when given within 3 hours of injury. Administration beyond 3 hours not only showed no benefit but was associated with increased mortality risk, likely due to a prothrombotic effect when the hyperfibrinolytic phase has ended. The benefit is greatest when given within the first hour. Current ATLS guidelines and UK military trauma protocols recommend TXA within 3 hours, ideally within 1 hour of injury.

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

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