In the CRASH-2 trial, tranexamic acid (TXA) was shown to reduce mortality from haemorrhagic trauma if given within a critical time window. After what time from injury does TXA become potentially harmful (associated with increased risk of death from bleeding)?
- A 3 hours ✓
- B 1 hour
- C 6 hours
- D 12 hours
Correct answer: A. 3 hours
Explanation
The CRASH-2 trial demonstrated that TXA given within 1 hour of injury reduces mortality most substantially (risk ratio 0.68), benefit is still present at 1-3 hours, but TXA given after 3 hours from injury was associated with a significant INCREASE in death from bleeding (risk ratio 1.44). Therefore, 3 hours is the critical cut-off beyond which TXA should not be administered for traumatic haemorrhage. Early administration is essential for maximum benefit.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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