The CRASH-2 trial evaluated tranexamic acid (TXA) in trauma. Which of the following accurately reflects the key finding and time-sensitive limitation of TXA administration?

• A TXA given up to 12 hours after injury reduces mortality and shows equal benefit at any time point
• B TXA reduces thromboembolic complications but does not affect mortality
• C TXA is only effective in penetrating trauma, not blunt trauma
• D TXA given within 3 hours of injury reduces mortality; administration after 3 hours may increase mortality ✓

Explanation

The CRASH-2 trial demonstrated that tranexamic acid (TXA, an antifibrinolytic) given within 3 hours of injury significantly reduces all-cause mortality in bleeding trauma patients (RR 0.91). Critically, the trial showed that TXA administered after 3 hours of injury appeared to increase the risk of death from hemorrhage, likely due to inhibition of fibrinolysis at a stage when fibrin clot resolution is needed. This established the 'three-hour window' for TXA administration in trauma, which is now incorporated in ATLS guidelines as a time-critical intervention with a loading dose of 1g IV over 10 minutes followed by 1g infusion over 8 hours.

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

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Written and medically reviewed by the StethoPrep medical team.