The CRASH-2 trial established which of the following regarding tranexamic acid (TXA) in trauma?

• A TXA reduces all-cause mortality by 25% regardless of time to administration
• B TXA should be given only to patients with confirmed coagulopathy on TEG/ROTEM
• C TXA is most beneficial when combined with recombinant Factor VIIa
• D TXA reduces mortality from haemorrhage when given within 3 hours of injury; benefit disappears and harm increases if given after 3 hours ✓

Explanation

CRASH-2 demonstrated that tranexamic acid significantly reduces all-cause mortality (RR 0.91) and haemorrhagic death (RR 0.85) in bleeding trauma patients when given within 3 hours of injury. Beyond 3 hours, TXA conferred no benefit and was associated with a significant increase in haemorrhagic death (RR 1.44). This time-sensitive effect forms the basis for the current recommendation to administer TXA as early as possible, within 3 hours, in all significantly injured patients.

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

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