The CRASH-2 trial demonstrated that tranexamic acid (TXA) reduces mortality in trauma patients when administered within 3 hours of injury. A 30-year-old male presents 3 hours 15 minutes after road traffic accident with significant hemorrhage. His systolic BP is 82 mmHg. What is the most appropriate action regarding TXA?
- A Administer TXA immediately as it still provides benefit
- B Do not administer TXA as it may increase mortality after 3 hours ✓
- C Administer half the standard dose beyond 3 hours
- D TXA is contraindicated in hypotensive patients
Correct answer: B. Do not administer TXA as it may increase mortality after 3 hours
Explanation
The CRASH-2 trial (Lancet 2010) showed that TXA significantly reduces all-cause mortality when given within 3 hours of injury, but importantly, TXA given more than 3 hours after injury was associated with increased mortality from hemorrhage. This harm signal at >3 hours is thought to be related to the natural pro-fibrinolytic phase reversing to a pro-thrombotic state over time, making antifibrinolytic therapy counterproductive or harmful. TXA must be given within 3 hours for benefit.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.